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Morita T, Takigawa C, Onishi H, Tajima T, Tani K, Matsubara T, Miyoshi I, Ikenaga M, Akechi T, Uchitomi Y. Opioid rotation from morphine to fentanyl in delirious cancer patients: an open-label trial. J Pain Symptom Manage 2005; 30:96-103. [PMID: 16043013 DOI: 10.1016/j.jpainsymman.2004.12.010] [Citation(s) in RCA: 74] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/22/2004] [Indexed: 01/03/2023]
Abstract
Although recent studies suggest that opioid rotation could be an effective treatment strategy for morphine-induced delirium, there have been no prospective studies to investigate the treatment effects of opioid rotation using fentanyl. The primary aim of this study was to clarify the efficacy of opioid rotation from morphine to fentanyl in symptom palliation of morphine-induced delirium. Twenty-one consecutive cancer patients with morphine-induced delirium underwent opioid rotation to fentanyl. Physicians recorded the symptom severity of delirium (the Memorial Delirium Assessment Scale, MDAS), pain, and other symptoms (categorical verbal scale from 0: none to 3: severe) and the Schedule for Team Assessment Scale (STAS) (from 0: none to 4: extreme); and performance status at the time of study enrollment and three and seven days after. Of 21 patients recruited, one patient did not complete the study. In the remaining 20 patients, morphine was substituted with transdermal fentanyl in 9 patients and parenteral fentanyl in 11 patients. Total opioid dose increased from 64 mg oral morphine equivalent/day (Day 0) to 98 mg/day (Day 7), and the median increase in total opioid dose was 42%. Treatment success, defined as an MDAS score below 10 and pain score of 2 or less, was obtained in 13 patients on Day 3 and 18 patients on Day 7. The mean MDAS score significantly decreased from 14 (Day 0) to 6.4 and 3.6 (Days 3 and 7, respectively, P < 0.001). Pain scores significantly decreased from 2.2 (Day 0) to 1.3 and 1.1 on the categorical verbal scale (Days 3 and 7, respectively, P < 0.001); from 2.6 (Day 0) to 1.6 and 1.3 on the STAS (Days 3 and 7, respectively, P < 0.001). Symptom scores of dry mouth, nausea, and vomiting significantly decreased, and performance status significantly improved. Opioid rotation from morphine to fentanyl may be effective in alleviating delirium and pain in cancer patients with morphine-induced delirium.
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Affiliation(s)
- Tatsuya Morita
- Department of Palliative and Supportive Care, Palliative Care Team and Seirei Hospice, Seirei Mikatahara Hospital, Hamamatsu, Shizuoka, Japan
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352
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de Rooij SE, Schuurmans MJ, van der Mast RC, Levi M. Clinical subtypes of delirium and their relevance for daily clinical practice: a systematic review. Int J Geriatr Psychiatry 2005; 20:609-15. [PMID: 16021665 DOI: 10.1002/gps.1343] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND Delirium is a disorder that besides four essential features consists of different combinations of symptoms. We reviewed the clinical classification of clusters of symptoms in two or three delirium subtypes. The possible implications of this subtype classification may be several. The investigation and exploration of clinical subtypes of delirium may provide information concerning the etiology, the pathogenesis, and the prognosis of delirium, but also may have therapeutic consequences. METHODS We searched several database for English-language articles. Selected articles were cross-checked for other relevant publications. DATA SYNTHESIS AND CONCLUSION We conducted a systematic review and retrieved ten clinical studies. The studies described in this review show different results, partly due to methodological problems and possibly by lack of a standard classification for delirium subtypes. According to the present literature a useful and reproducible method to classify (patterns of) symptoms in delirium subtypes seems to be the general rating of and division in to psychomotor subtypes. The Memorial Delirium Assessment Scale (MDAS) and the Dublin Delirium Assessment Scale (DAS) appear to be reliable methods, together with the new version of the Delirium Rating Scale (DRS-R-98).
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Affiliation(s)
- S E de Rooij
- Department of Internal Medicine, Geriatric section, Academic Medical Center, Amsterdam.
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353
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Brajtman S. Terminal restlessness: perspectives of an interdisciplinary palliative care team. Int J Palliat Nurs 2005; 11:170, 172-8. [PMID: 15924033 DOI: 10.12968/ijpn.2005.11.4.18038] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
AIM To explore an interdisciplinary team's perceptions of families' needs and experiences surrounding terminal restlessness. DESIGN A qualitative exploratory design using two focus groups. SAMPLE Participants were members of an interdisciplinary palliative care team working in a palliative care unit in a university teaching hospital in Israel. RESULTS The palliative care team confronted several challenging and stressful issues surrounding the management of terminal restlessness that influenced their treatment decisions and relationships with families. Four themes reflected the participants' perceptions and experiences: suffering, maintaining control, feelings of ambivalence and valuing communication to reduce conflict. CONCLUSION Findings suggest the need for comprehensive treatment plans to meet the special supportive and information needs of these families, specific supportive strategies for the professional caregivers and further studies to develop ethical criteria and evidence-based guidelines for the use of sedation in the management of terminal restlessness.
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Affiliation(s)
- Susan Brajtman
- School of Nursing, University of Ottawa, 451 Smyth Road, Ottawa, Ontario, Canada K1H 8M5.
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354
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Abstract
The key points of this article are anorexia and cachexia are: A major cause of cancer deaths. Several drugs are available to treat anorexia and cachexia. Dyspnea in cancer usually is caused by several factors. Treatment consists of reversing underlying causes, empiric bronchodilators, cortico-steroids--and in the terminally ill patients-opioids, benzodiazepines,and chlorpromazine. Delirium is associated with advanced cancer. Empiric treatment with neuroleptics while evaluating for reversible causes is a reasonable approach to management. Nausea and vomiting are caused by extra-abdominal factors (drugs,electrolyte abnormalities, central nervous system metastases) or intra-abdominal factors (gastroparesis, ileus, gastric outlet obstruction, bowel obstruction). The pattern of nausea and vomiting differs depending upon whether the cause is extra- or intra-abdominal. Reversible causes should be sought and empiric metoclopramide or haloperidol should be initiated. Fatigue may be caused by anemia, depression, endocrine abnormalities,or electrolyte disturbances that should be treated before using empiric methylphenidate. Constipation should be treated with laxatives and stool softeners. Both should start with the first opioid dose.
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Affiliation(s)
- Ruth L Lagman
- The Harry R. Horvitz Center for Palliative Medicine, Cleveland Clinic Taussig Cancer Center, The Cleveland Clinic Foundation, 9500 Euclid Avenue, M76 Cleveland, OH 44195, USA.
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355
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Milisen K, Steeman E, Foreman MD. Early detection and prevention of delirium in older patients with cancer. Eur J Cancer Care (Engl) 2005; 13:494-500. [PMID: 15606717 DOI: 10.1111/j.1365-2354.2004.00545.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Delirium poses a common and multifactorial complication in older patients with cancer. Delirium independently contributes to poorer clinical outcomes and impedes communication between patients with cancer, their family and health care providers. Because of its clinical impact and potential reversibility, efforts for prevention, early recognition or prompt treatment are critical. However, nurses and other health care providers often fail to recognize delirium or misattribute its symptoms to dementia, depression or old age. Yet, failure to determine an individual's risk for delirium can initiate the cascade of negative events causing additional distress for patients, family and health care providers alike. Therefore, parameters for determining an individual's risk for delirium and guidelines for the routine and systematic assessment of cognitive functioning are provided to form a basis for the prompt and accurate diagnosis of delirium. Guidelines for the prevention and treatment of delirium are also discussed.
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Affiliation(s)
- K Milisen
- Department of Geriatric Medicine, University Hospitals of Leuven & Center for Health Services and Nursing Research, Katholieke Universiteit Leuven, Leuven, Belgium.
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356
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Stagno D, Gibson C, Breitbart W. The delirium subtypes: A review of prevalence, phenomenology, pathophysiology, and treatment response. Palliat Support Care 2005; 2:171-9. [PMID: 16594247 DOI: 10.1017/s1478951504040234] [Citation(s) in RCA: 117] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Delirium is a highly prevalent disease in the elderly and postoperative, cancer, and AIDS patients. However it is often misdiagnosed and mistreated. This may be partly due to the inconsistencies of the diagnosis itself. Delirium is best defined currently by an association of cognitive impairment and arousal disturbance. Three subtypes (hyperactive, hypoactive, mixed) receive a definition in the literature, but those definitions may vary from author to author according to the importance they give either to the motoric presentation of the delirium or to the arousal disturbance. Our aim is to point out the inconsistencies we found in the literature, but also to identify different paths that have been explored to solve them, that is, the suggestion to emphasize the arousal disturbances in defining the subtypes instead of the motoric presentations, which seem to be more fluctuating, and because of the fluctuating course of the disease to extend the observation over a period of time, which may improve the accuracy of the diagnosis. This is not without importance from a clinical standpoint. Subtypes of delirium may be explained by different pathophysiologic mechanisms, which remain partly unexplained, and may respond to specific treatments. There is a trend to isolate core symptoms (disorientation, cognitive deficits, sleep–wake cycle disturbance, disorganized thinking, and language abnormalities) so as to distinguish them from secondary symptoms that may be correlated with the different etiologies. Our contribution is also to challenge, with new data, the accepted belief that psychotic features are quite rare in the hypoactive type of delirium. We demonstrate that delusions and perceptual disturbances, although less frequent, are present in more than half of the patients with hypoactive delirium. The psychotic features are clearly correlated with a highly prevalent rate of patients', spouses', and caregivers' distress. The mixed subtype of delirium seems to have the worst prognosis, the hyperactive showing the best prognosis. The treatment of the agitated delirious patient is also more consensual. Haloperidol remains the gold standard in the treatment of delirium regardless of the clinical presentation, but the literature provides several alternatives that may prove more specific and have less adverse effects (atypical antipsychotics, psychostimulants, anesthetics).
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Affiliation(s)
- Daniele Stagno
- Service de Psychiatrie de Liaison, CHUV-CH-1011 Lausanne, Switzerland.
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357
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Michaud L, Burnand B, Stiefel F. Taking care of the terminally ill cancer patient: delirium as a symptom of terminal disease. Ann Oncol 2005; 15 Suppl 4:iv199-203. [PMID: 15477308 DOI: 10.1093/annonc/mdh927] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Affiliation(s)
- L Michaud
- Centre of Clinical Epidemiology, Institute of Social Preventive Medicine, University of Lausanne, Switzerland
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358
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Yennurajalingam S, Braiteh F, Bruera E. Pain and Terminal Delirium Research in the Elderly. Clin Geriatr Med 2005; 21:93-119, viii. [PMID: 15639040 DOI: 10.1016/j.cger.2004.09.002] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
This article highlights new developments in assessment and management of pain and delirium.
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Affiliation(s)
- Sriram Yennurajalingam
- Department of Symptom Control and Palliative Care, University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 8, Houston, TX 77030-4095, USA
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359
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Fann JR, Alfano CM, Burington BE, Roth-Roemer S, Katon WJ, Syrjala KL. Clinical presentation of delirium in patients undergoing hematopoietic stem cell transplantation. Cancer 2005; 103:810-20. [PMID: 15643598 DOI: 10.1002/cncr.20845] [Citation(s) in RCA: 69] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
BACKGROUND Delirium is common in patients undergoing hematopoietic stem cell transplantation (HSCT) and is associated with considerable morbidity and excess mortality in diverse patient samples. Although delirium can be treated successfully, it is largely undiagnosed. Understanding the clinical presentation of delirium may help improve the recognition of delirium in these patients. In the current study, the authors investigated the clinical presentation of delirium in HSCT patients, including the time course of these symptoms and comorbid affective distress, fatigue, and pain. METHODS Ninety patients ages 22-62 years were recruited prior to undergoing their first allogeneic or autologous HSCT. Delirium, distress, and pain symptom assessments were conducted prospectively 3 times per week from pretransplantation through Day 30 posttransplantation. RESULTS Delirium episodes occurred in 50% of patients and lasted approximately 10 days, with peak severity at the end of the second week posttransplantation. Factor analysis revealed three groups of delirium symptoms representing psychosis-behavior, cognition, and mood-consciousness. Delirium episodes were characterized by rapid onset of psychomotor and sleep-wake cycle disturbance that persisted and cognitive symptoms that continued to worsen throughout much of the episode. Rises in psychosis-behavior and cognitive symptoms predated the start of delirium episodes by approximately 4 days. Affective distress and fatigue were common and appeared to be associated most with psychosis-behavioral delirium symptoms. CONCLUSIONS The results describe in detail the clinical presentation of delirium in patients undergoing HSCT. Affective distress and fatigue commonly were associated with delirium. These findings may aid clinicians in improving the recognition and treatment of delirium in this population and avoiding further morbidity and potential mortality.
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Affiliation(s)
- Jesse R Fann
- Department of Biobehavioral Sciences, Fred Hutchinson Cancer Research Center, Seattle, Washington 98195, USA.
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360
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Chochinov HM. Palliative care: an opportunity for mental health professionals. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2004; 49:347-9. [PMID: 15283528 DOI: 10.1177/070674370404900601] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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361
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362
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Morita T, Hirai K, Sakaguchi Y, Tsuneto S, Shima Y. Family-perceived distress from delirium-related symptoms of terminally ill cancer patients. PSYCHOSOMATICS 2004; 45:107-13. [PMID: 15016923 DOI: 10.1176/appi.psy.45.2.107] [Citation(s) in RCA: 89] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Delirium is a frequent symptom of terminally ill cancer patients and can cause serious distress to family members. To clarify the degree of emotional distress of family members concerning terminal delirium, a survey of bereaved families was performed. A questionnaire was mailed to 300 bereaved families with a request to rate the frequency and level of their distress for 12 delirium-related symptoms. A total of 195 responses were analyzed (effective response rate=65%). Seventy-four percent and 62% of the family members reported that the patients had symptoms of physical restlessness and mood lability, respectively. Psychotic symptoms, such as hallucinations and delusions, were reported by 35%-37%, and somnolence was reported in 92%. The prevalence of cognitive symptoms (e.g., communication difficulty, memory disturbance) ranged between 50% and 72%. More than two-thirds of the bereaved family members perceived all delirium-related symptoms other than somnolence as distressing or very distressing when they occurred "often" or "very often." For physical restlessness, mood lability, and psychotic symptoms that occurred "sometimes," 27%-36% of the family members had moderate to high levels of distress. The bereaved family members of terminally ill cancer patients experienced high levels of distress from both the agitation and cognitive symptoms of terminal delirium. Multidisciplinary interventions, including the prevention of agitation and the minimization of cognitive impairment, pharmacological or medical treatments, and supportive and psychoeducational approaches for family members, are needed to alleviate family distress.
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Affiliation(s)
- Tatsuya Morita
- Seiri Hospice, Seiri Mikatabara Hospital, the Graduate School of Human Sciences, Osaka University, Osaka, Japan.
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363
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Abstract
Delirium in advanced cancer is often poorly identified and inappropriately managed. It is one of the most common causes for admission to clinical institutions and is the most frequently cited psychiatric disorder in terminal cancer. Diagnosis of delirium is defined as a disturbance of consciousness and attention with a change in cognition and/or perception. In addition, it develops suddenly and follows a fluctuating course and it is related to other causes, such as cancer, metabolic disorders or the effects of drugs. Delirium occurs in 26% to 44% of cancer patients admitted to hospital or hospice. Of all advanced cancer patients, over 80% eventually experience delirium in their final days. In advanced cancer, delirium is a multifactorial syndrome where opioids factor in almost 60% of episodes. Delirium in such patients, excluding terminal delirium, may be reversible in 50% of cases. Providing adequate end-of-life care for a patient with delirium is the main challenge. The family needs advice and it is important to create a relaxing environment for the patient. The primary therapeutic approach is to identify the reversible causes of delirium. Some therapeutic strategies have been shown to be effective: reduction or withdrawal of the psychoactive medication, opioid rotation, and hydration. Haloperidol is the most frequently used drug, and new neuroleptics such as risperidone or olanzapine are being tested with good results. Methylphenidate has been used for hypoactive delirium.
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Affiliation(s)
- Carlos Centeno
- Centro Regional de Cuidados Paliativos y Tratamiento del Dolor, Hospital Los Montalvos, Salamanca, Spain.
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364
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Capuzzo M, Valpondi V, Cingolani E, De Luca S, Gianstefani G, Grassi L, Alvisi R. Application of the Italian version of the Intensive Care Unit Memory tool in the clinical setting. Crit Care 2004; 8:R48-55. [PMID: 14975055 PMCID: PMC420064 DOI: 10.1186/cc2416] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2003] [Revised: 11/04/2003] [Accepted: 11/21/2003] [Indexed: 12/31/2022] Open
Abstract
INTRODUCTION The aims of the present study were to assess patients' memories of their stay in the intensive care unit (ICU) over time, using the Italian version of the ICU Memory (ICUM) tool, and to examine the relationship between memory and duration of ICU stay and infection. PATIENTS AND METHOD Adult patients consecutively admitted to a four-bed ICU of a university hospital, whose stay in the ICU was at least 3 days, were prospectively studied. The ICUM tool was administered twice: face to face 1 week after ICU discharge to 93 patients (successfully in 87); and by phone after 3 months to 67 patients. Stability of memories over time was analyzed using Kappa statistics. RESULTS Delusional memories appeared to be the most persistent recollections over time (minimum kappa value = 0.68), followed by feelings (kappa value > 0.7 in three out of six memories) and factual memories (kappa value > 0.7 in three out of 11 memories). The patients without a clear memory of their stay in the ICU reported a greater number of delusional memories than did those with a clear memory. Of patients without infection 35% had one or two delusional memories, and 60% of patients with infection had one to four delusional memories (P = 0.029). CONCLUSION The ICUM tool is of value in a setting and language different from those in which it was created and used. Delusional memories are the most stable recollections, and are frequently associated both with lack of clear memory of ICU experience and with presence of infection during ICU stay.
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Affiliation(s)
- Maurizia Capuzzo
- Department of Surgical, Anaesthetic and Radiological Sciences, Section of Anaesthesiology and Intensive Care, University Hospital of Ferrara, Ferrara, Italy.
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365
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Skrobik YK, Bergeron N, Dumont M, Gottfried SB. Olanzapine vs haloperidol: treating delirium in a critical care setting. Intensive Care Med 2003; 30:444-9. [PMID: 14685663 DOI: 10.1007/s00134-003-2117-0] [Citation(s) in RCA: 265] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2003] [Accepted: 11/26/2003] [Indexed: 02/06/2023]
Abstract
OBJECTIVE To compare the safety and estimate the response profile of olanzapine, a second-generation antipsychotic, to haloperidol in the treatment of delirium in the critical care setting. DESIGN Prospective randomized trial. SETTING Tertiary care university affiliated critical care unit. PATIENTS All admissions to a medical and surgical intensive care unit with a diagnosis of delirium. INTERVENTIONS Patients were randomized to receive either enteral olanzapine or haloperidol. MEASUREMENTS Patient's delirium severity and benzodiazepine use were monitored over 5 days after the diagnosis of delirium. MAIN RESULTS Delirium Index decreased over time in both groups, as did the administered dose of benzodiazepines. Clinical improvement was similar in both treatment arms. No side effects were noted in the olanzapine group, whereas the use of haloperidol was associated with extrapyramidal side effects. CONCLUSIONS Olanzapine is a safe alternative to haloperidol in delirious critical care patients, and may be of particular interest in patients in whom haloperidol is contraindicated.
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Affiliation(s)
- Yoanna K Skrobik
- Department of Critical Care, Maisonneuve Rosemont Hospital, Université de Montreal, 5415 boul de l'Assomption, Montreal, Quebec H1T 2M4, Canada.
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366
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Morita T, Tei Y, Inoue S. Agitated Terminal Delirium and Association with Partial Opioid Substitution and Hydration. J Palliat Med 2003; 6:557-63. [PMID: 14516497 DOI: 10.1089/109662103768253669] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Delirium is often a distressing symptom for both patients and their families, and its prevention is important. The primary aim of this study was to clarify the effects of partial opioid substitution and hydration on the occurrence of agitated delirium in the final stage of cancer. METHODS An historical control study on consecutive terminally ill cancer patients admitted to a palliative care unit (164 in 1996-1997 and 120 in 2000-2001). In 2000-2001, we actively performed hydration and partial opioid substitution from morphine with fentanyl on individual grounds. Two independent raters evaluated the degree of agitation and cognitive impairment during the final week, using the Memorial Delirium Assessment Scale, the Agitation Distress Scale, the Communication Capacity Scale, and a consciousness scale. RESULTS Compared to 1996-1997, in 2000-2001, the use of artificial hydration (33% to 44%, p = 0.053) and opioid rotation (3.0% to 41%, p < 0.01) increased, while there were no statistically significant differences in hydration volume, the mean dose, and the high-dose requirements of morphine. The prevalence of agitated delirium, the agitation score, the percentage of patients achieving clear-complex communication, and the percentage of patients who maintained clear consciousness did not significantly change. CONCLUSIONS Partial opioid substitution with fentanyl and moderate levels of hydration had no significant preventive effects on the occurrence of agitated delirium in the last week on a mass level. We should explore new strategies to prevent agitated delirium that are practically available in Japan.
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Affiliation(s)
- Tatsuya Morita
- Seirei Hospice, Seirei Mikatabara Hospital, 3453 Mikatabara-cho, Hamamatsu, Shizuoka 433-8558, Japan.
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367
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Greenberg DB. Preventing Delirium at the End of Life: Lessons From Recent Research. PRIMARY CARE COMPANION TO THE JOURNAL OF CLINICAL PSYCHIATRY 2003; 5:62-67. [PMID: 15156232 PMCID: PMC353038 DOI: 10.4088/pcc.v05n0201] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/31/2002] [Accepted: 03/03/2003] [Indexed: 10/20/2022]
Abstract
Preservation of the ability to think clearly, in comfort, is a goal of end-of-life care. Recent research on delirium at the end of life suggests clinical strategies for prevention of cognitive impairment. Clinicians should consider early warnings of mild delirium such as impairment in attention and short-term memory by following the patient's ability to remember 3 words or to attend to digit span before the patient is disoriented. If cognitive impairment is noted, clinicians should pay attention to reversible causes. This article reviews clinical concerns about opiates, benzodiazepines, steroids, hepatic encephalopathy, timely use of neuroleptic medications, and caretaking strategies at home.
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368
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Current awareness in geriatric psychiatry. Int J Geriatr Psychiatry 2002; 17:887-94. [PMID: 12369568 DOI: 10.1002/gps.581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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