A retrospective study of the psychiatric management and outcome of delirium in the cancer patient

Abstract

This report describes the evaluation and treatment of delirium in the cancer patient in a major comprehensive cancer center. Ninety consecutive cases of delirium seen by the inpatient psychiatry consultation/liaison service were analyzed in a retrospective fashion to evaluate demographic information, alcohol use, central nervous system disease, coexisting medical disease, and past psychiatric history. Delirium cases were divided into hyperalert, hypoalert, and mixed subtypes. For these three subtypes, medication profiles including dose of medication, duration of delirium, outcome, and the venue where the delirium began were also evaluated. The hyperalert subtype of delirium was the commonest type observed (71%) and had the shortest duration (P < 0.0001) and best outcome (P < 0.001). The patients with a hyperalert delirium subtype were treated with the least amount of haloperidol (P < 0.0001). Patients were delirious for longer when the delirium began in the intensive-care units (P < 0.04). In general, patients who received no haloperidol experienced delirium of longer duration (P < 0.02) than those receiving haloperidol. Since the data represent patients who were referred for psychiatric treatment, this may explain the increased number of hyperalert deliriums and, therefore, the generalizability of the results is limited. Delirium in the cancer patient is particularly problematic given the coexisting medical problems these patients experience. Because the outcome of delirium is better when the duration is shorter, it is important for clinicians to be sensitive to early symptoms so that treatment can be implemented faster, leading to less morbidity and mortality.

Prevalence, phenomenology and etiology of delirium in medically ill patients

“…23,24 It has been suggested that the subtypes differ in the underlying pathology, response to therapeutic intervention and outcome, with hypoactive delirium having a notably poorer prognosis although some studies have not found such an association. 25,26 Hypoactive delirium is likely to go undiagnosed thereby resulting in poorer prognosis. Hyperactive delirium is preferentially referred for management by psychiatrist because of disturbed behavior, disorientation, irrelevant talk and decreased sleep.…”

Opioid medications and longitudinal risk of delirium in hospitalized cancer patients

“…According to the available literature, the evidence linking these 2 classes of medications to delirium seems to be weaker than that for opioids, 3 although all 3 groups of medications are plausible risk factors from a biologic standpoint. 30 Benzodiazepines and corticosteroids have been associated with delirium in case series [31][32][33][34] (a rather weak study design). 35 In cohort and case-control studies, no significant associations were identified between corticosteroids and delirium, whereas benzodiazepines were associated significantly with delirium in 1 study.…”

Incidence, Clinical Features and Subtypes of Delirium in Elderly Patients Treated for Hip Fractures

“…Among those studies, the results are confl icting. The hyperactive subtype was more common in two studies [9,11] , the hypoactive subtype was more frequent in one study [12] and the mixed subtype was more frequent in three studies [7,8,13] . There is only one study on delirium in the elderly, showing that the hypoactive subtype was the most frequent subtype of delirium [12] .…”