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48 - Delirium

Published online by Cambridge University Press:  04 August 2010

Peter G. Lawlor
Affiliation:
University of Alberta Hospital, Edmonton
Michael J. Fisch
Affiliation:
University of Texas, M. D. Anderson Cancer Center
Eduardo Bruera
Affiliation:
University of Texas, M. D. Anderson Cancer Center
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Summary

Introduction

Delirium is a common and frequently distressing neuropsychiatric complication in cancer patients. It has been defined as a transient global disorder of cognition and attention. These features are highlighted in the Diagnostic and Statistical Manual of Mental Disorders (4th edition; DSM–IV) core diagnostic criteria for delirium (Table 48.1), which also includes perceptual disturbance, acuity of onset (hours to days), fluctuation in clinical features, and the presence of an underlying cause, such as a general medical condition, substance induced, multiple etiologies, or unknown etiology. Delirium is associated with increased morbidity and mortality, prolonged hospital stay, and especially in the elderly, an increased requirement for institutional care.

Epidemiological aspects

Delirium occurrence rates in the range of 8–88% have been reported in hospitalized cancer patients. This wide range likely represents differences in diagnostic criteria, and populations selected on the basis of admission to different settings (for example, early versus advanced disease) or referral to different consult services such as psychiatry or neurology. Prospective studies have reported delirium in 40% of advanced cancer patients on hospital admission and in almost 90% of these patients in the last hours or days prior to death. Despite its remarkable frequency as a terminal event, delirium reversal has been reported in approximately 50% of episodes.

Clinical features

Delirium is a syndrome with protean manifestations. Perceptual disturbance, one of the potential core criteria, includes misperceptions, illusions, and hallucinations. Hallucinations are most commonly visual but tactile and auditory types can also occur.

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Publisher: Cambridge University Press
Print publication year: 2003

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References

American Psychiatric Association. Practice guideline for the treatment of patients with delirium. Am J Psychiatry 1999;156 (Suppl.):1–20
Breitbart, W, Marotta, R, Platt, M. A double-blind trial of haloperidol, chlorpromazine, and lorazepam in the treatment of delirium in hospitalized AIDS patients. Am J Psychiatry 1996;153:231–7Google ScholarPubMed
Bruera, E, Miller, L, McCallion, J, Macmillan, K, Krefting, L, Hanson, J. Cognitive failure in patients with terminal cancer: a prospective study. J Pain Symptom Manage 1992;7:192–5CrossRefGoogle ScholarPubMed
Bruera, E, Franco, J J, Maltoni, M, Watanabe, S, Suarez-Almazor, M. Changing pattern of agitated impaired mental status in patients with advanced cancer: association with cognitive monitoring, hydration, and opioid rotation. J Pain Symptom Manage 1995;10:287–91CrossRefGoogle ScholarPubMed
Stoutz, N D, Bruera, E, Suarez-Almazor, M. Opioid rotation for toxicity reduction in terminal cancer patients. J Pain Symptom Manage 1995;10:378–84CrossRefGoogle ScholarPubMed
Inouye, S K, Dyck, C H, Alessi, C A, Balkin, S, Siegal, A P, Horwitz, R I. Clarifying confusion: the confusion assessment method. A new method for detection of delirium. Ann Intern Med 1990;113:941–8CrossRefGoogle Scholar
Lawlor, P G, Gagnon, B, Mancini, I L. Occurrence, causes, and outcome of delirium in advanced cancer patients: a prospective study. Arch Intern Med 2000;160:786–94CrossRefGoogle ScholarPubMed
Massie, M J, Holland, J, Glass, E. Delirium in terminally ill cancer patients. Am J Psychiatry 1983;140:1048–50Google ScholarPubMed
Tuma, R, DeAngelis, L M. Altered mental status in patients with cancer. Arch Neurol 2000;57:1727–31CrossRefGoogle ScholarPubMed
Lawlor, P G, Fainsinger, R L, Bruera, E D. Delirium at the end of life. J Am Med Assoc 2000;284:2427–9CrossRefGoogle ScholarPubMed
Lipowski, Z J. Delirium in the elderly patient. N Engl J Med 1989;320:578–82Google ScholarPubMed
Meagher, D J. Delirium: optimising management. Br Med J 2001;322:144–9CrossRefGoogle ScholarPubMed
National Cancer Institute and National Institute of Health, Supportive Care PDQ section. http://www.cancer.gov/cancer\_information/coping/
American Psychiatric Association. Practice guideline for the treatment of patients with delirium. Am J Psychiatry 1999;156 (Suppl.):1–20
Breitbart, W, Marotta, R, Platt, M. A double-blind trial of haloperidol, chlorpromazine, and lorazepam in the treatment of delirium in hospitalized AIDS patients. Am J Psychiatry 1996;153:231–7Google ScholarPubMed
Bruera, E, Miller, L, McCallion, J, Macmillan, K, Krefting, L, Hanson, J. Cognitive failure in patients with terminal cancer: a prospective study. J Pain Symptom Manage 1992;7:192–5CrossRefGoogle ScholarPubMed
Bruera, E, Franco, J J, Maltoni, M, Watanabe, S, Suarez-Almazor, M. Changing pattern of agitated impaired mental status in patients with advanced cancer: association with cognitive monitoring, hydration, and opioid rotation. J Pain Symptom Manage 1995;10:287–91CrossRefGoogle ScholarPubMed
Stoutz, N D, Bruera, E, Suarez-Almazor, M. Opioid rotation for toxicity reduction in terminal cancer patients. J Pain Symptom Manage 1995;10:378–84CrossRefGoogle ScholarPubMed
Inouye, S K, Dyck, C H, Alessi, C A, Balkin, S, Siegal, A P, Horwitz, R I. Clarifying confusion: the confusion assessment method. A new method for detection of delirium. Ann Intern Med 1990;113:941–8CrossRefGoogle Scholar
Lawlor, P G, Gagnon, B, Mancini, I L. Occurrence, causes, and outcome of delirium in advanced cancer patients: a prospective study. Arch Intern Med 2000;160:786–94CrossRefGoogle ScholarPubMed
Massie, M J, Holland, J, Glass, E. Delirium in terminally ill cancer patients. Am J Psychiatry 1983;140:1048–50Google ScholarPubMed
Tuma, R, DeAngelis, L M. Altered mental status in patients with cancer. Arch Neurol 2000;57:1727–31CrossRefGoogle ScholarPubMed
Lawlor, P G, Fainsinger, R L, Bruera, E D. Delirium at the end of life. J Am Med Assoc 2000;284:2427–9CrossRefGoogle ScholarPubMed
Lipowski, Z J. Delirium in the elderly patient. N Engl J Med 1989;320:578–82Google ScholarPubMed
Meagher, D J. Delirium: optimising management. Br Med J 2001;322:144–9CrossRefGoogle ScholarPubMed
National Cancer Institute and National Institute of Health, Supportive Care PDQ section. http://www.cancer.gov/cancer\_information/coping/

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  • Delirium
  • Edited by Michael J. Fisch, University of Texas, M. D. Anderson Cancer Center, Eduardo Bruera, University of Texas, M. D. Anderson Cancer Center
  • Book: Handbook of Advanced Cancer Care
  • Online publication: 04 August 2010
  • Chapter DOI: https://doi.org/10.1017/CBO9780511527081.049
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  • Delirium
  • Edited by Michael J. Fisch, University of Texas, M. D. Anderson Cancer Center, Eduardo Bruera, University of Texas, M. D. Anderson Cancer Center
  • Book: Handbook of Advanced Cancer Care
  • Online publication: 04 August 2010
  • Chapter DOI: https://doi.org/10.1017/CBO9780511527081.049
Available formats
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Save book to Google Drive

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Google Drive.

  • Delirium
  • Edited by Michael J. Fisch, University of Texas, M. D. Anderson Cancer Center, Eduardo Bruera, University of Texas, M. D. Anderson Cancer Center
  • Book: Handbook of Advanced Cancer Care
  • Online publication: 04 August 2010
  • Chapter DOI: https://doi.org/10.1017/CBO9780511527081.049
Available formats
×