Meera Agar1, Peter Lawlor. 1. Department of Palliative and Supportive Services, Flinders University, Bedford Park, South Australia. meera.agar@sswahs.nsw.gov.au
Abstract
PURPOSE OF REVIEW: Delirium is a neuropsychiatric syndrome that occurs frequently in cancer patients, especially in those with advanced disease. Recognition and effective management of delirium is particularly important in supportive and palliative care, especially in view of the projected increase in the elderly population and the consequent potential for the number of patients both diagnosed and living longer with cancer to increase substantively. RECENT FINDINGS: Studies of delirium in a variety of settings have generated new insights into phenomenology, assessment tools, the psychomotor subtypes, potential patho-physiological markers, pathogenesis, reversibility, and the role of sedation in symptom control. SUMMARY: Validated tools exist to assist in the assessment of delirium. Although our understanding of the pathogenesis of delirium has improved somewhat, there remains a compelling need to further elucidate the underlying pathophysiology, especially in relation to opioids and the other psychoactive medications that are used in supportive care. Further trials are needed, especially in patients with advanced disease to determine predictive models of reversibility, preventive strategies, outcomes, and to assess the role of antipsychotic and other medications in symptomatic management.
PURPOSE OF REVIEW: Delirium is a neuropsychiatric syndrome that occurs frequently in cancerpatients, especially in those with advanced disease. Recognition and effective management of delirium is particularly important in supportive and palliative care, especially in view of the projected increase in the elderly population and the consequent potential for the number of patients both diagnosed and living longer with cancer to increase substantively. RECENT FINDINGS: Studies of delirium in a variety of settings have generated new insights into phenomenology, assessment tools, the psychomotor subtypes, potential patho-physiological markers, pathogenesis, reversibility, and the role of sedation in symptom control. SUMMARY: Validated tools exist to assist in the assessment of delirium. Although our understanding of the pathogenesis of delirium has improved somewhat, there remains a compelling need to further elucidate the underlying pathophysiology, especially in relation to opioids and the other psychoactive medications that are used in supportive care. Further trials are needed, especially in patients with advanced disease to determine predictive models of reversibility, preventive strategies, outcomes, and to assess the role of antipsychotic and other medications in symptomatic management.
Authors: Shirley H Bush; Salmaan Kanji; José L Pereira; Daniel H J Davis; David C Currow; David Meagher; Kiran Rabheru; David Wright; Eduardo Bruera; Michael Hartwick; Pierre R Gagnon; Bruno Gagnon; William Breitbart; Laura Regnier; Peter G Lawlor Journal: J Pain Symptom Manage Date: 2014-01-28 Impact factor: 3.612
Authors: Scott A Irwin; Rosene D Pirrello; Jeremy M Hirst; Gary T Buckholz; Frank D Ferris Journal: J Palliat Med Date: 2013-03-12 Impact factor: 2.947
Authors: Peter G Lawlor; Daniel H J Davis; Mohammed Ansari; Annmarie Hosie; Salmaan Kanji; Franco Momoli; Shirley H Bush; Sharon Watanabe; David C Currow; Bruno Gagnon; Meera Agar; Eduardo Bruera; David J Meagher; Sophia E J A de Rooij; Dimitrios Adamis; Augusto Caraceni; Katie Marchington; David J Stewart Journal: J Pain Symptom Manage Date: 2014-04-12 Impact factor: 3.612