Psychoactive Medications and Risk of Delirium in Hospitalized Cancer Patients

Gaudreau, Jean–David; Gagnon, Pierre; Harel, François; Roy, Marc‐André; Tremblay, Annie

doi:10.1200/jco.2005.05.140

Cited by 163 publications

(112 citation statements)

References 23 publications

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“…In our ICU patients, however, a diuretic (furosemide) which is known to have anticholinergic side-effects was administered in nearly 85% of patients, and no marked differences in SAA levels were obtained between the delirious and non-delirious subgroups (data not shown). Therefore, it is more likely that delirium is associated with specific, centrally acting drugs [31,32]. In the present study, patients receiving long-term medication for psychiatric and neurological disorders not included.…”

Section: Discussionmentioning

confidence: 99%

EEG changes and serum anticholinergic activity measured in patients with delirium in the intensive care unit

Plaschke

Hill²,

Engelhardt

et al. 2007

Anaesthesia

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SummaryThe aim of this study was to examine whether serum anticholinergic activity (SAA) is a reliable indicator of delirium in the ICU, and whether there is a significant correlation between SAA and quantitative electroencephalographic (EEG) data in delirious patients. In a prospective cohort study, we assessed ICU patients diagnosed with delirium (n = 37). EEG measurements and blood analysis including SAA were performed 48 h following ICU admission. The presence of delirium was evaluated using the Confusion Assessment Method for critically ill patients in ICU (CAM-ICU). The SAA level was measured using a competitive radioreceptor binding assay for muscarinergic receptors and quantitative EEG was measured using the CATEEM Ò system. We found that, under comparable conditions, patients in the delirium group showed a higher relative EEG theta power and a reduced alpha power (n = 17) than did the non-delirious patients (n = 20). No difference in measured SAA levels were seen; therefore, there was no correlation between SAA and EEG measurements in delirious patients. We conclude that, in contrast to the EEG, the SAA level cannot be proposed as a tool for diagnosing delirium in ICU patients.

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Section: Discussionmentioning

confidence: 99%

EEG changes and serum anticholinergic activity measured in patients with delirium in the intensive care unit

Plaschke

Hill²,

Engelhardt

et al. 2007

Anaesthesia

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“…2 The dichotomization of doses did not compromise the results, because the difference in the fit of models with medications as dichotomous versus continuous variables was not statistically significant 2 based on the likelihood-ratio chi-square statistic. 1 .…”

Section: Variablesmentioning

confidence: 99%

“…Consecutive incident cases of delirium from our previous work, which examined the role of psychoactive medications in delirium occurrence 2 (n ¼ 43 patients), were included in the current study along with the enrollment of 71 new incident delirium cases. The 2 phases of enrollment were conducted in the same manner.…”

Section: Patientsmentioning

confidence: 99%

“…1,2 One possible explanation is the high exposure rate of such patients to drugs prone to induce delirium. Contrary to common clinical wisdom, however, very few psychoactive medications were identified repeatedly as delirium risk factors in large-scale studies.…”

mentioning

confidence: 99%

“…3 The quality of research in drug-induced delirium has been questionable methodologically in the past 3 ; however, the results from a recent and rigorously conducted study suggest that psychoactive medications, such as benzodiazepines, corticosteroids, and opioids, increase the risk of developing delirium during hospitalization in oncology patients. 2 Clearly, determining that such drugs are associated with delirium onset is an important step toward better patient management. The longitudinal analysis of factors associated with delirium is particularly valuable from the standpoint of evidence-based medicine.…”

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confidence: 99%

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Opioid medications and longitudinal risk of delirium in hospitalized cancer patients

Gaudreau

Gagnon

Roy

et al. 2007

Cancer

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BACKGROUND.Delirium is an important problem in hospitalized cancer patients. The objective of this study was to determine whether exposure to corticosteroids, benzodiazepines, or opioids predicted delirium.METHODS.A prospective cohort study was conducted in an oncology/internal medicine population. Patients were assessed continuously for the presence of delirium until they were discharged by using the Nursing Delirium Screening Scale (Nu‐DESC). Follow‐up for outcome began after incident delirium. The primary outcome was the presence of a delirium event, which was defined as a Nu‐DESC score >1. Strengths of associations of medications with delirium were expressed as odds ratios (ORs) in univariate and multivariate analyses.RESULTS.In total, 114 patients (1823 patient‐days) met the inclusion criteria for the study. The mean follow‐up from incident delirium was 16 days. The mean number of delirium events by patient was 6 (total number, 667 delirium events). Analysis by day on several occasions revealed significant associations between opioids and delirium. Corticosteroids and benzodiazepines were not associated significantly with an increased risk of delirium on any given day. Analysis by patient using generalized estimating equation (GEE) models showed an increased risk of delirium on any day of follow‐up associated with opioid exposure in univariate analysis (OR of 1.70; P < .0001). The association remained significant after adjustment for corticosteroid, benzodiazepine, and antipsychotic exposure using GEE regressions (OR of 1.37; P = .0033). Truncating follow‐up at 30 days did not affect the results (OR of 1.38; P < .032).CONCLUSIONS.Exposure to opioids during hospitalization was associated significantly with an increased longitudinal risk of delirium. Cancer 2007. © 2007 American Cancer Society.

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Agitation and Delirium at the End of Life

2008

JAMA

172

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Delirium is the most common neuropsychiatric complication experienced by patients with advanced illness, occurring in up to 85% of patients in the last weeks of life. Using the case of Mr L, a 59-year-old man with metastatic lung cancer who developed an agitated delirium in the last week of life, we review the evaluation and management of delirium near the end of life. Although some studies have identified agitation as a central feature of delirium in 13% to 46% of patients, other studies have found up to 80% of patients near the end of life develop a hypoactive, nonagitated delirium. Both the agitated (hyperactive) and nonagitated (hypoactive) forms of delirium are harbingers of impending death and are associated with increased morbidity in patients who are terminally ill, causing distress for patients, family members, and staff. Delirium is a sign of significant physiological disturbance, usually involving multiple causes, including infection, organ failure, and medication adverse effects. Often these causes of delirium are not reversible in the dying patient, and this influences the outcomes of its management. Delirium can also significantly interfere with the recognition and control of other physical and psychological symptoms, such as pain. Unfortunately, delirium is often misdiagnosed or unrecognized and thus inappropriately treated or untreated in terminally ill patients. To manage delirium in terminally ill patients, clinicians must be able to diagnose it accurately, undertake appropriate assessment of underlying causes, and understand the benefits and risks of the available pharmacological and nonpharmacological interventions.

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Psychoactive Medications and Risk of Delirium in Hospitalized Cancer Patients

Abstract: Exposure to opioids, corticosteroids, and benzodiazepines is independently associated with an increased risk of delirium in hospitalized cancer patients.

Cited by 163 publications

References 23 publications

EEG changes and serum anticholinergic activity measured in patients with delirium in the intensive care unit

EEG changes and serum anticholinergic activity measured in patients with delirium in the intensive care unit

Opioid medications and longitudinal risk of delirium in hospitalized cancer patients

Agitation and Delirium at the End of Life

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