Delirium Treatment in Hospitalized Palliative Care Patients: Systematic Review
DOI:
https://doi.org/10.24950/rspmi.826Keywords:
Delirium/psychology, Delirium/therapy, Palliative CareAbstract
Delirium is an acute change in mental status that may fluctuate
and has underlying physiological causes. It is a common
and serious problem amongst palliative care hospitalized
patients. Our aim was to perform a systematic review
on the recent scientific evidence (between April 2011 and
August 2015) concerning the treatment of delirium in this
population. From the 2539 articles, we include nine. Two of
them were about non-pharmacological strategies in frail old
patients. We found only one comparative study that shows
similarity in the efficacy of haloperidol and aripiprazole, although
more adverse effects were found in the first one. Aripiprazole
appears to be less effective in hyperactive delirium
treatment. Melatonin analogues are between the new drugs
under investigation. Guidelines mostly derive from experts or
from studies that exclude palliative care patients. Prospective
comparative studies, with a placebo arm, longer follow-
-up, double blinded and randomized are needed. Concerning
patients with palliative needs that develop delirium it is
urgent to evaluate the potential reversibility of the episode,
ensuring support to caregivers and adopting pharmacological
or non-pharmacological measures that benefit the quality
of life and the goals of both patient and family.
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References
Lawlor P, Davis D, Ansari M, Hosie A, Kanji S, Momoli F, et al. An AnalyticalnFramework for Delirium Research in Palliative Care Settings: Integrated Epidemiologic, Clinician-Researcher, and Knowledge User Perspectives. J Pain Symptom Manage. 2014;48:159-75.
American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 5th ed. Philadelphia: APA; 2013.
Milisen K, Lemiengre J, Braes T, Foreman MD. Multicomponent intervention strategies for managing delirium in hospitalized older people; systematic review. J Adv Nurs. 2005; 52:79–90.
Wei LA, Fearing MA, Sternberg EJ, Inouye SK. The confusion assessment method: a systematic review of current usage. J Am Geriatr Soc. 2008; 56:823–30.
Spiller JA, Keen JC. Hypoactive delirium: assessing the extent of the problem for inpatient specialist palliative care. Palliat Med. 2006; 20:17–23.
Hosie A, Davidson P, Agar M, Sanderson C, Phillips J. Delirium prevalence, incidence, and implications for screening in specialist palliative
care inpatient settings: a systematic review. Palliat Med. 2013;27:486-98.
Lawlor G, Fainsinger L, Bruera D. Delirium at the end of life: critical issues in clinical practice and research. JAMA. 2000; 284: 2427-9.
Candy B, Jackson K, Jones L, Leurent B, Tookman A, King M. Drug therapy for delirium in terminally ill adult patients. Cochrane Database Syst
Rev. 2012. [consultado em Jan 2016] Disponível em: www.update-software.com/pdf/CD004770.pdf.
Bruera E, Bush S, Willey J, Paraskevopoulos T, Li Z, Palmer JL, et al. Impact of delirium and recall on the level of distress in patients with advanced cancer and their family caregivers. Cancer. 2009;115:2004-12.
Bush S, Bruera E, Lawlor P, Kanji S, Davis D, Agar M. Clinical Practice Guidelines for Delirium Management: Potential Application in Palliative Care. J Pain Symptom Manage. 2014;48:249-58.
Ford A, Almeida O. Pharmacological interventions for preventing delirium in the elderly. Maturitas. 2015;81:287-92.
Lawlor P, Gagnon B, Mancini I Pereira J, Hanson J, Suarez-Almazor M, et al. Occurrence causes, and outcome of delirium in patients with advanced cancer: a prospective study. Arch Intern Med. 2000;160:786–94.
Gagnon P, Allard P, Gagnon B, Merette C, Tardif F. Delirium prevention in terminal cancer: assessment of a multi-component intervention. Psycooncology. 2012;21:187-94.
Sánchez-Román S, Zavala C, Solares A, Chiquete E. Delirium in adult patients receiving palliative care: A systematic review of the literature.
Rev Psiquiatr Salud Ment. 2014;7:48-58.
Bellelli G, Morandi A, Zanetti E, Bozzini M, Lucchi E, Terrasi M, et al. Recognition and management of delirium among doctors, nurses, physiotherapists, and psychologists: an Italian survey. Int Psychogeriatr. 2014;26:2093–102.
Rainsford S, Rosenberg J, Bullen T. Delirium in advanced cancer: screening for the incidence on admission to an inpatient hospice unit. J Palliat Med. 2014;17:1045–8.
Sato K, Inoue Y, Umeda M, Ishigamori I, Igarashi A, Togashi S, et al. A Japanese region-wide survey of the knowledge, difficulties and self-
reported palliative care practices among nurses. Jpn J Clin Oncol. 2014;44:718–28.
Morita T, Tei Y, Tsunoda J, Inoue S, Chihara S. Underlying pathologies and their associations with clinical features in terminal delirium of cancer patients. J Pain Symptom Manage. 2001; 22:997–1006.
Thomas K. The Gold Standards Framework Centre In End of Life Care. Prognostic Indicator Guidance (PIG) 4th ed.London: PIG; 2011.
Kham B, Zawahiri M, Campbell N, Fox G, Weinstein E, Nazir A, et al. Delirium in Hospitalized Patients: Implications of Current Evidence on Clinical Practice and Future Avenues for Research – A Systematic Evidence Review. J Hosp Med. 2012;7:580-9.
Higgins JPT, Green S. Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0. The Cochrane Collaboration 2011. [consultado em Jan 2016] Disponível em: http://handbook.cochrane.org.
Inouye S, van Dyck C, Alessi C, Balkin S, Siegal A, Horwitz R. Clarifying confusion: the confusion assessment method. A new method for detecting delirium. Ann Intern Med. 1990;113:941–8.
Yoo W, Seol H, Kim J, Yang M, Ryu S, Min D. Effects of hospitalist-directed interdisciplinary medicine floor service on hospital outcomes for
seniors with acute medical illness. Geriatr Gerontol Int. 2014;14:71-7.
Eeles E, Thompson L, McCrow J, Pandy S. Management of delirium in medicine: experience of a Close Observation Unit. Australas J Ageing.
;32:60-3.
Yoo W, Nakagawa S, Kim S. Delirium and transition to a nursing home of hospitalized older adults: a controlled trial of assessing the interdisciplinary team-based geriatric care and care coordination by non-geriatrics specialist physicians. Geriatr Gerontol Int. 2013;13:342-50.
Yoon J, Park M, Choi J, Choi H, Park Y, Kim J. Efficacy and safety of haloperidol versus atypical antipsychotic medications in the treatment of
delirium. BMC Psychiatry. 2013;13:240.
Yang J, Choi W, Ko H, Joe H, Han C, Kim K. Bright light therapy as an adjunctive treatment with risperidone in patients with delirium: a randomized, open, parallel group study. Gen Hosp Psychiatry. 2012;34:546-51.
Ohta T, Murao K, Miyake K, Takemoto K. Melatonin receptor agonists for treating delirium in elderly patients with acute stroke. J Stroke Cerebrovasc Dis. 2013;22:1107-10.
Zirker W, Dorokhine I, Knapp M, Patel N, Musuku M. Haloperidol overdosing in the treatment of agitated hospitalized older people with delirium: a retrospective chart review from a community teaching hospital. Drugs Aging. 2013;30:639-44.
Boettger S, Breitbart W. An open trial of aripiprazole for the treatment of delirium in hospitalized cancer patients. Palliat Support Care. 2011;9:351-7.
Boettger S, Passik S, Breitbart W. Treatment characteristics of delirium superimposed on dementia. Int Psychogeriatr. 2011;23:1671-6.
Boettger S, Friedlander M, Breitbart W, Passik S. Aripiprazole and haloperidol in the treatment of delirium. Aust N Z J Psychiatry. 2011;45:477-82.
Chong S, Tan T, Tay L, Wong M, Ancoli-Israel S. Bright light therapy as part of a multicomponent management program improves sleep and
functional outcomes in delirious older hospitalized adults. Clin Interv Aging. 2013;8:565-72.
Furuya M, Miyaoka T, Yasuda H, Yamashita S, Tanaka I, Otsuka S, et al. Marked improvement in delirium with ramelteon: five case reports. Psychogeriatrics. 2012; 12:259-62.
Gonçalves F, Almeida A, Pereira S. A Protocol for the Control of Agitation in Palliative Care. Am J Hosp Palliat Care. 2015 (in press)
Hayakawa K, Kato T, Kohjiro M, Monji A, Kanba S. Minocycline, a microglial inhibitor, diminishes terminal patients´ delirium? Am J Geriatr
Psychiatry. 2014;22:314-5.
Kishi Y, Kato M, Okuyama T, Thurber S. Treatment of delirium with risperidone in cancer patients. Psychiatry Clin Neurosci. 2012;66:411-7.
Bee L, Chew P, Sian M. Functional improvement in hospitalized older adults is independent of dementia diagnosis: experience of a specialized delirium management unit. J Hosp Med. 2013; 8:321-7.
Breitbart W, Marotta R, Platt M, Weisman H, Derevenco M, Grau C, et al. A double-blind trial of haloperidol, chlorpromazine, and lorazepam in the treatment of delirium in hospitalized AIDS patients. Am J Psychiatry. 1996;153:231-7.
Hui D, Bush S, Gallo L, Palmer J, Yennurajalingam S, Bruera E. Neuroleptic Dose in the Management of Delirium in Patients with Advanced
Cancer. J Pain Symptom Manage. 2010;39:186-96.
Prommer E. Role of Haloperidol in Palliative Medicine: An Update. Am J Hosp Palliat Care. 2012;29 295-301.
Lindqvist O, Lundquist G, Dickman A, Bükki J, Lunder U, Hagelin CL, et al. OPCARE9. Four essential drugs needed for quality care of the dying: a Delphi-study based international expert consensus opinion. J Palliat Med. 2013;16:38–43.
DeLeon A, Patel C, Crismon L. Aripiprazole: A comprehensive review of its pharmacology, clinical efficacy, and tolerability. Clinical Therapeutics. 2004;26:649–66.
Vella-Brincat J, Macleod A. Haloperidol in palliative care. Palliat Med. 2004;18:195-201.
Chakraborti D, Tampi D, Tampi R. Melatonin and Melatonin Agonist for Delirium in the Elderly Patients. Am J Alzheimers Dis Other Demen.
;30:119-29.
Simpson D, Curran P. Ramelteon: a review of its use in insomnia. Drugs. 2008;68:1901-19.
Agar M. Oral risperidone, oral haloperidol, and oral placebo in the management of delirium in palliative care. 2013. [consultado em Jan 2016] Disponível em: http://apps.who.int/trialsearch/trial.aspx?trialid1⁄4ACTRN12607000562471.
Khan B, Zawahiri M, Campbell N, Fox G, Weinstein E, Nazir A, et al. Delirium in Hospitalized Patients: Implications of Current Evidence on Clinical Practice and Future Avenues for Research - A Systematic Evidence Review. J Hosp Med. 2012; 7: 580–9.
Bush S, Kanji S, Pereira J, Davis D, Currow D, Meagher D, et al. Treating an established episode of delirium in palliative care: expert opinion and review of the current evidence base with recommendations for future development. J Pain Symptom Manage. 2014 ; 48: 231–48.
Irwin S, Pirrello R, Hirst J, Buckholz G, Ferris F. Clarifying delirium management: practical, evidenced-based, expert recommendations for clinical practice. J Palliat Med. 2013;16:423–35.
Zimmerman K, Rudolph J, Salow N, Skarf L. Delirium in Palliative Care Patients: Focus on Pharmacotherapy. Am J Hosp Palliat Care. 2011;28:501-10.
Bush S, Leonard M, Agar M, Spiller J, Hosie A, Wright D. End-of-Life Delirium: Issues Regarding Recognition, Optimal Management, and the Role of Sedation in the Dying Phase. J Pain Symptom Manage. 2014;48:215-30.
de Graeff A, Dean M. Palliative sedation therapy in the last weeks of life: a literature review and recommendations for standards. J Palliat Med. 2007; 10:67–85.
Gagnon P, Charbonneau C, Allard P, Soulard C, Dumont S, Fillion L. Delirium in advanced cancer: A psychoeducational intervention for family caregivers. J Palliat Care. 2002;18:253–61.
Rosenbloom-Brunton D, Henneman E, Inouye S. Feasibility of family participation in a delirium prevention program for hospitalized older adults. J Gerontol Nurs. 2010;36:22–33.
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