title: Management of delirium in palliative care: a review.
abstract: Delirium is a complex but common disorder in palliative care with a prevalence between 13 and 88 % but a particular frequency at the end of life (terminal delirium). By reviewing the most relevant studies (MEDLINE, EMBASE, PsycLit, PsycInfo, Cochrane Library), a correct assessment to make the diagnosis (e.g., DSM-5, delirium assessment tools), the identification of the possible etiological factors, and the application of multicomponent and integrated interventions were reported as the correct steps to effectively manage delirium in palliative care. In terms of medications, both conventional (e.g., haloperidol) and atypical antipsychotics (e.g., olanzapine, risperidone, quetiapine, aripiprazole) were shown to be equally effective in the treatment of delirium. No recommendation was possible in palliative care regarding the use of other drugs (e.g., α-2 receptors agonists, psychostimulants, cholinesterase inhibitors, melatonergic drugs). Non-pharmacological interventions (e.g., behavioral and educational) were also shown to be important in the management of delirium. More research is necessary to clarify how to more thoroughly manage delirium in palliative care.
authors: Institute of Psychiatry, Department of Biomedical and Specialty Surgical Sciences, University of Ferrara, Corso Giovecca 203, 44121, Ferrara, Italy, luigi.grassi@unife.it.
authors: Luigi
authors: L
authors: Grassi
authors: Augusto
authors: A
authors: Caraceni
authors: Alex J
authors: AJ
authors: Mitchell
authors: Maria Giulia
authors: MG
authors: Nanni
authors: Maria Alejandra
authors: MA
authors: Berardi
authors: Rosangela
authors: R
authors: Caruso
authors: Michelle
authors: M
authors: Riba
mesh_terms: D014150:Antipsychotic Agents / Q000627:therapeutic use*; D000068180:Aripiprazole / Q000008:administration & dosage; D001569:Benzodiazepines / Q000008:administration & dosage; D002800:Cholinesterase Inhibitors / Q000627:therapeutic use; D003693:Delirium / Q000188:drug therapy* / Q000453:epidemiology / Q000209:etiology* / Q000523:psychology / Q000628:therapy; D019468:Disease Management; D006220:Haloperidol / Q000008:administration & dosage; D006282:Health Personnel / Q000193:education; D006801:Humans; D000077152:Olanzapine; D010166:Palliative Care / Q000379:methods / Q000523:psychology; D000069348:Quetiapine Fumarate / Q000008:administration & dosage; D018967:Risperidone / Q000008:administration & dosage
chemical_list: D014150:Antipsychotic Agents; D002800:Cholinesterase Inhibitors; D001569:Benzodiazepines; D000069348:Quetiapine Fumarate; D000068180:Aripiprazole; D006220:Haloperidol; D018967:Risperidone; D000077152:Olanzapine