Delirium is a complex but common disorder in palliative care with a prevalence between 13% to 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 intervention, were reported as the correct steps to effectively manage delirium in palliative care. In terms of medications, both conventional (namely 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 inhinbitors, melatonergic drugs). Non-pharmacological intervention (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.
Management of Delirium in Palliative Care: a review
GRASSI, Luigi;NANNI, Maria Giulia;CARUSO, Rosangela;
2015
Abstract
Delirium is a complex but common disorder in palliative care with a prevalence between 13% to 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 intervention, were reported as the correct steps to effectively manage delirium in palliative care. In terms of medications, both conventional (namely 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 inhinbitors, melatonergic drugs). Non-pharmacological intervention (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.I documenti in SFERA sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
