Presentación clínica e identificación del delirium en el cáncer avanzado

The delirium is under treated and poorly identified in terminal cancer. Many times requires hospitalisation (26-44%) and it is the most frequent psychiatric diagnosis at the end of life. Delirium is characterized by a disturbance of consciousness, cognition, and perception, with fluctuating course and sudden start. Usually it is possible to find a relation between delirium episode and drugs, metabolic disturbances, or the cancer itself. In advanced cancer, a multifactorial etiology is most common, but opioids are implicated in more than 60% of the cases. Almost 50% of the episodes of delirium are reversible as it is shown in recent prospective studies. Often the delirium is evident but other times delirium episodes are not detected by physicians or nurses. However, it is possible to improve recognition with the use of the proper terminology, team training in delirium recognition, and assessing cognitive function with the Mini-Mental State Examination (MMSE) or others. This test in most settings, is recommended as the test of choice for detecting changes in cognitive function. Anyway, delirium diagnosis is clinical and bedside made, after a careful history looking at the clinical curse and comparing with the previous situation. When we fail to detect and treat delirium, symptoms control (restlessness, confusion, sleep disturbances, unease, etc.) may be impossible. The consequences are distressing for the patient and destructive for the team.