Delirium em Doentes com Cancro em Contexto de Cuidados Paliativos
DOI:
https://doi.org/10.51338/rppsm.2021.v.i1.162Palavras-chave:
Antipsicóticos, Cuidados Paliativos, Delírio, Neoplasias/complicaçõesResumo
O delirium é uma síndrome neuropsiquiátrica complexa e multifatorial, altamente prevalente em todos os contextos de cuidados paliativos, nomeadamente em doentes com cancro. Pretende‑se com este artigo, com base na literatura atual, rever critérios de diagnóstico de delirium e suas características clínicas; instrumentos utilizados para avaliação; etiologia e patofisiologia; prevenção e estratégias terapêuticas nesta população específica. Foi revista a literatura publicada na base de dados online PubMed/Medline, entre 1987 e 2020, que abordasse o tratamento do delirium em contexto paliativo, através das palavras‑chave: delirium, cancer e palliative care. Embora a disfunção cerebral global associada ao delirium se manifeste por sintomas e sinais neurocognitivos ou neuropsiquiátricos, a característica fundamental desta síndrome é a perturbação da atenção. A etiologia do delirium é considerada multifatorial e o seu diagnóstico é pouco reconhecido pelos profissionais de saúde. Segundo a literatura, são necessárias várias estratégias de tratamento, tendo em conta os diversos fatores precipitantes, mecanismos patofisiológicos, subtipos e diferenças fenomenológicas encontrados no delirium. Apesar de largamente utilizados na prática clínica, não existe evidência suficiente para o uso habitual de antipsicóticos no tratamento do delirium em contexto paliativo. Do ponto de vista global, o objetivo deverá ser o tratamento de uma possível causa reversível e a otimização das estratégias não farmacológicas, sendo o uso de antipsicóticos reservado para os casos graves, de risco eminente, e refratários. Assim, a abordagem de tratamento do delirium em contexto de cuidados paliativos, deverá ter em conta os diversos subtipos de delirium, baseados nas diferentes etiologias, contextos e prognósticos, havendo necessidade de mais e melhores estudos, tanto do ponto de vista farmacológico como em estratégias combinadas, com clarificação de resultados que permitam aferir eficácia na resolução do quadro clínico e na qualidade de vida nesta população.
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