TY - JOUR
T1 - Neuroleptic Dose in the Management of Delirium in Patients with Advanced Cancer
AU - Hui, David
AU - Bush, Shirley H.
AU - Gallo, Laura E.
AU - Palmer, J. Lynn
AU - Yennurajalingam, Sriram
AU - Bruera, Eduardo
N1 - Funding Information:
Drs. Hui and Bush contributed equally to this study. Dr. Bruera is supported in part by National Institutes of Health grant numbers RO1NR010162-01A1 , RO1CA122292-01 , and RO1CA124481-01 . Dr. Hui is funded by a fellowship from the Clinician Investigator Program, Royal College of Physicians and Surgeons of Canada.
PY - 2010/2
Y1 - 2010/2
N2 - Neuroleptics are commonly used in the management of delirium. Limited information is available regarding the dosage requirements and efficacy of neuroleptics in the palliative care setting. We determined the type and dose of neuroleptic use by delirium subtype. The medical records of 99 inpatients with advanced cancer were reviewed retrospectively. The doses of different neuroleptics, expressed as haloperidol equivalent daily doses (HEDDs), were correlated with delirium recall, recalled delirium symptom frequency, and associated distress from the patients', family caregivers', nurses' and palliative care specialists' perspectives. Subtypes of delirium included hypoactive in 20 (20%), mixed in 66 (67%), and hyperactive in 13 (13%). The median HEDD was 2.5 mg, interquartile range (Q1-Q3) 1-4.7 mg (mean 4.0 ± 5.9 mg), and it was significantly higher in agitated and mixed delirium as compared with hypoactive delirium (P = 0.008). The neuroleptic dose was low and appeared to be ineffective in preventing patient delirium recall, with 73 (74%) patients remembering their episode of delirium as distressing. HEDD did not correlate with delirium recall, recalled symptom frequency, or distress for patients and family caregivers. However, HEDD increased with nurses' distress related to patients' symptoms (disorientation to place P = 0.002, disorientation to time P = 0.008, delusions P = 0.041, and agitation P < 0.001), and palliative care specialists' distress related to patients' hallucinatory symptoms (P = 0.006) and agitation (P = 0.006). In this study, the administered neuroleptic dose was influenced more by health care professional distress than by delirium symptom frequency. Future studies should examine the efficacy of neuroleptic dose according to individual delirium symptoms.
AB - Neuroleptics are commonly used in the management of delirium. Limited information is available regarding the dosage requirements and efficacy of neuroleptics in the palliative care setting. We determined the type and dose of neuroleptic use by delirium subtype. The medical records of 99 inpatients with advanced cancer were reviewed retrospectively. The doses of different neuroleptics, expressed as haloperidol equivalent daily doses (HEDDs), were correlated with delirium recall, recalled delirium symptom frequency, and associated distress from the patients', family caregivers', nurses' and palliative care specialists' perspectives. Subtypes of delirium included hypoactive in 20 (20%), mixed in 66 (67%), and hyperactive in 13 (13%). The median HEDD was 2.5 mg, interquartile range (Q1-Q3) 1-4.7 mg (mean 4.0 ± 5.9 mg), and it was significantly higher in agitated and mixed delirium as compared with hypoactive delirium (P = 0.008). The neuroleptic dose was low and appeared to be ineffective in preventing patient delirium recall, with 73 (74%) patients remembering their episode of delirium as distressing. HEDD did not correlate with delirium recall, recalled symptom frequency, or distress for patients and family caregivers. However, HEDD increased with nurses' distress related to patients' symptoms (disorientation to place P = 0.002, disorientation to time P = 0.008, delusions P = 0.041, and agitation P < 0.001), and palliative care specialists' distress related to patients' hallucinatory symptoms (P = 0.006) and agitation (P = 0.006). In this study, the administered neuroleptic dose was influenced more by health care professional distress than by delirium symptom frequency. Future studies should examine the efficacy of neuroleptic dose according to individual delirium symptoms.
KW - Delirium
KW - haloperidol
KW - neoplasms
KW - neuroleptic agents
KW - palliative care
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UR - http://www.scopus.com/inward/citedby.url?scp=75749120617&partnerID=8YFLogxK
U2 - 10.1016/j.jpainsymman.2009.07.009
DO - 10.1016/j.jpainsymman.2009.07.009
M3 - Article
C2 - 20152585
AN - SCOPUS:75749120617
SN - 0885-3924
VL - 39
SP - 186
EP - 196
JO - Journal of pain and symptom management
JF - Journal of pain and symptom management
IS - 2
ER -