섬망 치료에 있어서 지프라시돈(Ziprasidone)과 리스페리돈(Risperidone)의 효과 비교

Abstract

Objectives：It has been shown that risperidone, an atypical antipsychotics, has effectiveness for treatment of delirium as good as haloperidol and has less side effects than haloperidol. Ziprasidone also has less extrapyramidal and anticholinergic side effects, but there has been little information published on ziprasidone for the treatment of patients with delirium. Therefore, this study investigated whether ziprasidone had effectiveness for treatment of delirium and whether there was a differential effect between risperidone and ziprasidone. Methods：Sixteen patients with delirium were enrolled in this study. All subjects(16 patients) were randomized to receive either risperidone(7 patients) or ziprasidone(9 patients) with fixed dose at the first day of treatment. Risperidone group was given 1mg and ziprasidone group was given 20mg at the first day of treatment in the night. Then, all subjects received either medications with flexible doses according to judgement on clinical status of patients. The effectiveness was evaluated using Clinical Global Impression-Severity(CGI-S), Korean version of Delirium Rating Scale(K-DRS), Korean Mini Mental Status Examination(K-MMSE), and Korean version of Delirium Rating Scale-Revised-98. The side effects was evaluated using Extrapyramidal Symptom Rating Scale(ESRS) which was administered by a trained psychiatrist. Results：There was no significant difference between both groups in the baseline K-DRS, K-DRS-R-98, KMMSE and CGI scores. At the seventh day of the treatment, K-DRS, K-DRS-R-98 and CGI scores were significantly decreased from the baseline in the ziprasidone treatment group, but not in risperidone treatment group. Conclusion：These results suggest that ziprasidone appears to be more effective than risperidone for treatment of delirium.

본 연구에서는 가장 최근에 개발된 비전형 항정신병 약물인 ziprasidone이 섬망의 치료에 효과가 있는지와 비전형 항정신병 약물인 risperidone과 효과의 차이가 있는지 평가하고자 하였다. 총 16명의 환자가 본 연구대상에 포함되었고 CGI, K-DRS, K-DRS-R-98, K-MMSE를 평가 도구로 하여 치료 전과 치료 일 주일 후 측정한 전체 점수를 비교하였다. 부작용에 대한 평가도구로는 ESRS 점수를 치료후에 비교하였다. 연구 결과 risperidone군에서는 일 주일 후 측정한 CGIS, K-DRS, K-MMSE, K-DRS-R-98에서 통계학적으로 유의한 차이가 없었으나 ziprasidone군에서는 CGI-S, K-DRS, K-DRS-R-98에서 통계학적으로 유의한 차이가 있었다. 부작용은 두 군에서 큰 차이가 없는 것으로 나타났다. 향후 표본의 수를 늘려 많은 자료를 축적하는 것이 필요하지만 ziprasidone이 섬망환자에게 비교적 안전하게 사용할 수 있는 약물 중 하나일 것으로 기대된다.