Korean J Hosp Palliat Care.  2016 Sep;19(3):201-210. 10.14475/kjhpc.2016.19.3.201.

Delirium Management: Diagnosis, Assessment, and Treatment in Palliative Care

Affiliations
  • 1Department of Family Medicine, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Incheon, Korea.
  • 2Department of Palliative Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea. sharp1003@catholic.ac.kr

Abstract

Delirium is a common symptom in patients with terminal cancer. The prevalence increases in the dying phase. Delirium causes negative effects on quality of life for both patients and their families, and is associated with higher mortality. However, some studies reported that it tends to remain unrecognized in palliative care setting. That may be related with difficulties to distinguish the symptom from others with overlapping characteristics such as depression and dementia, and a lack of knowledge regarding assessment and diagnostic tools. We suggest that accurate recognition with validated tools and early diagnosis of the symptom should be highly prioritized in delirium management in palliative care setting. After diagnosing delirium, it is important to identify and address reversible precipitants such as medication, dehydration, and infection. Non-pharmacological interventions including comfortable environment for the patient and family education are also essential in the management strategy. If such interventions prove ineffective or insufficient to control hyperactive symptoms, pharmacologic interventions with antipsychotics and benzodiazepine can be considered. Until now, low levels of haloperidol remains the standard treatment despite a lack of evidence. Atypical antipsychotics such as olanzapine, quetiapine and risperidone reportedly have similar efficacy with a stronger sedating property and less adverse effect compared to haloperidol. Currently, delirium medications that can be used in palliative care setting require more clinical trials, and thus, clinical guidelines are not sufficiently available. We suggest that it is warranted to develop clinical guidelines based on well-designed clinical studies for palliative care patients.

Keyword

Delirium; Palliative care; Neoplasm; Antipsychotic agents

MeSH Terms

Antipsychotic Agents
Benzodiazepines
Dehydration
Delirium*
Dementia
Depression
Diagnosis*
Early Diagnosis
Education
Haloperidol
Humans
Mortality
Palliative Care*
Prevalence
Quality of Life
Quetiapine Fumarate
Risperidone
Antipsychotic Agents
Benzodiazepines
Haloperidol
Quetiapine Fumarate
Risperidone
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