Delirium

Delirium is an acute confusional state resulting from diffuse organic brain dysfunction. It is one of the most common neuropsychiatric syndromes in patients with advanced cancer. Delirium occurs in all age groups but is more common in the elderly. It is frequently missed or misinterpreted as worsening pain or other symptoms in the emergency department. The significant morbidity and mortality associated with this syndrome can lead to high distress levels for patients, their families, and medical staff. The diagnosis is based on the presence of specific criteria in the Diagnostic and Statistical Manual of Mental Disorders and requires a high index of suspicion. Approximately 50% of episodes are reversible. Delirium is a predictor of shorter survival of cancer patients and makes the assessment of pain and symptoms difficult. The management of delirium depends on identifying and reversing the cause, if known, and includes pharmacological and non-pharmacological interventions focused on preserving patient safety and integrity while minimizing unnecessary stress. These include discontinuing offending medications (opioids in particular), treating infections, and rehydrating the patient, if appropriate. Antipsychotic medications are used mainly to control symptoms. In refractory delirium, palliative sedation may be needed.