Delirium management in patients with cancer: Dosing of antipsychotics in the delirium subtypes and response to psychopharmacological management Journal Article

  


Authors: Boettger, S.; Jenewein, J.; Breitbart, W.
Article Title: Delirium management in patients with cancer: Dosing of antipsychotics in the delirium subtypes and response to psychopharmacological management
Abstract: Background: While delirium resolution and persistent delirium in hypoactive and hyperactive delirium have been studied to a certain extent, doses of antipsychotics administered remain unknown. Methods: Patients treated for cancer were recruited at the Memorial Sloan Kettering Cancer Center (MSKCC). Socio-demographic, medical variables, the Memorial Delirium Assessment Scale (MDAS) subitems (1-10) as well as the Karnofsky scale of Performance Status (KPS) were recorded at baseline (T1), 2-3 days (T2) and 4-7 days (T3) and analyzed in respect to the subtypes of delirium and medication doses administered. Results: Between haloperidol, risperidone, olanzapine and aripiprazole, differences existed in respect to the prevalence of dementia, stage of illness, baseline MDAS scores, delirium resolution, and functional status. When hyperactive delirium was present, doses reached fourfold those administered in hypoactive delirium. In particular, haloperidol and olanzapine were administered at higher doses in order to achieve symptom control. When aripiprazole was administered, dosing was similar between the subtypes. Generally, the response to management with antipsychotics was similar between the delirium subtypes, although a trend towards a greater response in hypoactive delirium was noted. However, factors known to cause persistent delirium influenced delirium resolution. Conclusion: The interaction of factors contributing to resolved and persistent delirium in the hypoactive and hyperactive subtype remains complex. In general, the response was comparable between the subtypes. However, patients with hyper-active delirium required higher doses of antipsychotics in order to achieve symptom control.
Keywords: delirium; management; delirium subtypes; delirium resolution; dosing of antipsychotics
Journal Title: German Journal of Psychiatry
Volume: 17
Issue: 1
ISSN: 1433-1055
Publisher: University of Goettingen  
Date Published: 2014-04-25
Start Page: 10
End Page: 18
Language: English
PROVIDER: scopus
DOI/URL:

http://www.scopus.com/inward/record.url?eid=2-s2.0-84899739105&partnerID=40&md5=c3fa8a98270ed7fd39b78c46be77187a
Notes: Germ. J. Psychiatry -- Export Date: 2 June 2014 -- CODEN: GJPEA -- Source: Scopus