Management of Delirium in Palliative Care: a Review

Abstract

Delirium is a complex but common disorder in palliative care with a prevalence between 13 and 88 % but a particular frequency at the end of life (terminal delirium). By reviewing the most relevant studies (MEDLINE, EMBASE, PsycLit, PsycInfo, Cochrane Library), a correct assessment to make the diagnosis (e.g., DSM-5, delirium assessment tools), the identification of the possible etiological factors, and the application of multicomponent and integrated interventions were reported as the correct steps to effectively manage delirium in palliative care. In terms of medications, both conventional (e.g., haloperidol) and atypical antipsychotics (e.g., olanzapine, risperidone, quetiapine, aripiprazole) were shown to be equally effective in the treatment of delirium. No recommendation was possible in palliative care regarding the use of other drugs (e.g., α-2 receptors agonists, psychostimulants, cholinesterase inhibitors, melatonergic drugs). Non-pharmacological interventions (e.g., behavioral and educational) were also shown to be important in the management of delirium. More research is necessary to clarify how to more thoroughly manage delirium in palliative care.

Updates in palliative care – recent advancements in the pharmacological management of symptoms

“…17 Between 30-50% of delirious episodes are precipitated by potentially reversible causes including infection, faecal or urinary retention, electrolyte imbalances and medications (toxicity or withdrawal). 18 These reversible causes should be sought, reversed if appropriate, and non-pharmacological treatments optimised. 19 Traditional clinical management of symptomatic hyperactive delirium has included both antipsychotics and benzodiazepines (especially in severe cases where the patient is a risk to themselves or others).…”

An integrative literature review exploring the clinical management of delirium in patients with advanced cancer

“…Patients with cancer are at particular risk of developing delirium for a number of reasons, including exposure to certain drugs (opioids, corticosteroids and benzodiazepines) (Gaudreau, Gagnon, Harel, Roy, & Tremblay, 2005), and the presence of bone metastases and haematological malignancies (Ljubisavljevic & Kelly, 2003). In a recent literature review, it was concluded that there needs to be a greater understanding of delirium in palliative care, including its pathophysiology and causation, as well as its treatment (Grassi et al, 2015). and that bowel movements are monitored.…”

Palliative Care in the Emergency Department

“…The antipsychotics are commonly used to treat delirium in clinical settings and in PC. Several metaanalyses have shown that antipsychotics are effective treatments for delirium 45,46 (Table 4).…”