The Delirium Experience: Delirium Recall and Delirium-Related Distress in Hospitalized Patients With Cancer, Their Spouses/Caregivers, and Their Nurses

Breitbart, William; Gibson, Christopher; Tremblay, Annie

doi:10.1176/appi.psy.43.3.183

Cited by 517 publications

(487 citation statements)

References 38 publications

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“…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.…”

Section: Discussionmentioning

confidence: 99%

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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Section: Discussionmentioning

confidence: 99%

Opioid medications and longitudinal risk of delirium in hospitalized cancer patients

Gaudreau

Gagnon

Roy

et al. 2007

Cancer

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“…6 very distressing to families and challenging for the health care team, and further compounded at the end of life by impeded communication as a result of the delirium (11,12). A recent systematic review of palliative sedation suggests that delirium is one of the most common indications for palliative sedation (13).…”

Section: A C C E P T E D Accepted Manuscriptmentioning

confidence: 99%

“…Patients who have recovered from an episode of delirium report significant distress, for both hyperactive and hypoactive clinical subtypes (11,12). In contrast to aged care and intensive care populations, there is currently insufficient evidence to support non-pharmacological approaches in the management of delirium at the end of life (32,56).…”

Section: Symptomatic Treatment Of Delirium In the Terminal Phasementioning

confidence: 99%

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End-of-Life Delirium: Issues Regarding Recognition, Optimal Management, and the Role of Sedation in the Dying Phase

Bush

Leonard

Agar

et al. 2014

Journal of Pain and Symptom Management

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Context. In end-of-life care, delirium is often not recognized and poses unique management challenges, especially in the case of refractory delirium in the terminal phase.Objectives. To review: delirium in the terminal phase context, specifically in relation to recognition issues; the decision-making processes and management strategies regarding its reversibility; the potential refractoriness of delirium to symptomatic treatment; and the role of sedation in refractory delirium. Methods.We combined multidisciplinary input from delirium researchers and knowledge users at an international delirium study planning meeting and relevant electronic database literature searches (Ovid Medline, Embase, PsycINFO and CINAHL) to inform this narrative review.Results. The overall management strategy for delirium at the end of life is directed by the patient's prognosis in association with the patient's goals of care. As symptoms of delirium are often refractory in the terminal phase, especially in the case of agitated delirium, the judicious use of palliative sedation is frequently required. However, there remains a lack of high level evidence for the management of delirium in the terminal phase, including the role of antipsychotics and optimal sedation strategies. For the family and health care staff, clear communication, education and emotional support are vital components to assist with decision making and direct the treatment care plan. Conclusion.Further research on the effectiveness of delirium management strategies in the terminal phase for patients and their families is required. Further validation of assessment tools for diagnostic screening and severity measurement are needed in this patient population.

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“…Some have suggested that absence of oxygen or decreased oxygen getting to the brain, as a common final pathway to brain death, might be implicated in NDEs. However, decreased oxygen is a highly distressing experience, particularly for those who report perceptual distortions and hallucinations [60]. The distress and agitation typical of decreased oxygen contrast markedly with NDEs, which are usually recalled as peaceful and positive experiences [2,3].…”

Section: Physiological Explanationsmentioning

confidence: 99%

Western Scientific Approaches to Near-Death Experiences

Greyson

2015

Humanities

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Near-death experiences (NDEs) are vivid experiences that often occur in life-threatening conditions, usually characterized by a transcendent tone and clear perceptions of leaving the body and being in a different spatiotemporal dimension. Such experiences have been reported throughout history in diverse cultures, and are reported today by 10% to 20% of people who have come close to death. Although cultural expectations and parameters of the brush with death influence the content of some NDEs, near-death phenomenology is invariant across cultures. That invariance may reflect universal psychological defenses, neurophysiological processes, or actual experience of a transcendent or mystical domain. Research into these alternative explanations has been hampered by the unpredictable occurrence of NDEs. Regardless of the causes or interpretations of NDEs, however, they are consistently associated with profound and long-lasting aftereffects on experiencers, and may have important implications for non-experiencers as well.

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The Delirium Experience: Delirium Recall and Delirium-Related Distress in Hospitalized Patients With Cancer, Their Spouses/Caregivers, and Their Nurses

Cited by 517 publications

References 38 publications

Opioid medications and longitudinal risk of delirium in hospitalized cancer patients

Opioid medications and longitudinal risk of delirium in hospitalized cancer patients

End-of-Life Delirium: Issues Regarding Recognition, Optimal Management, and the Role of Sedation in the Dying Phase

Western Scientific Approaches to Near-Death Experiences

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