Delirium among Patients with Cancer in Palliative Care
DOI:
https://doi.org/10.51338/rppsm.2021.v.i1.162Keywords:
Antipsychotic Agents, Delirium, Neoplasms/complications, Palliative CareAbstract
Delirium is a complex and multifactorial neuropsychiatric syndrome, highly prevalent in all palliative care settings, particularly among cancer patients. This article aims, based on the current literature, to revise the diagnostic criteria of delirium, its clinical manifestations; assessment tools; etiology and pathophysiology; and treatment strategies for this condition in this specific population. The review was conduct based on published articles in PubMed/Medline about delirium management in palliative care, between 1987 and 2020, using the keywords: delirium, cancer and palliative care.
Although the global brain dysfunction associated with delirium is exhibited by neurocognitive or neuropsychiatric symptoms and signs, the fundamental characteristic of this syndrome is attention disorder. The etiology of delirium is considered multifactorial and its diagnosis is poorly recognized by health professionals. According to literature, diverse strategies are necessary to deal with delirium’s precipitant factors, pathophysiological mechanisms, subtypes and phenomenological differences. Although highly used in clinical practice, routinely use of antipsychotics in delirium management at palliative care is not an evidence‑based approach. In summary, the aim should always be to find and treat any reversible cause and enhance non‑pharmacological approaches, with antipsychotics reserved for severe, life‑threatening and refractory cases. Thus, the treatment approach to delirium in the context of palliative care, should consider the different subtypes of delirium, based on different etiologies, contexts and prognoses, with a need for more and better studies, both from the pharmacological point of view and in combined strategies, with clarification of results regarding efficacy in the resolution of the clinical syndrome and in the quality of life in this population.
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