Abstract
This report describes the evaluation and treatment of delirium in the cancer patient in a major comprehensive cancer center. Ninety consecutive cases of delirium seen by the inpatient psychiatry consultation/liaison service were analyzed in a retrospective fashion to evaluate demographic information, alcohol use, central nervous system disease, coexisting medical disease, and past psychiatric history. Delirium cases were divided into hyperalert, hypoalert, and mixed subtypes. For these three subtypes, medication profiles including dose of medication, duration of delirium, outcome, and the venue where the delirium began were also evaluated. The hyperalert subtype of delirium was the commonest type observed (71%) and had the shortest duration (P <0.0001) and best outcome (P <0.001). The patients with a hyperalert delirium subtype were treated with the least amount of haloperidol (P <0.0001). Patients were delirious for longer when the delirium began in the intensivecare units (P < 0.04). In general, patients who received no haloperidol experienced delirium of longer duration (P < 0.02) than those receiving haloperidol. Since the data represent patients who were referred for psychiatric treatment, this may explain the increased number of hyperalert deliriums and, therefore, the generalizability of the results is limited. Delirium in the cancer patient is particularly problematic given the coexisting medical problems these patients experience. Because the outcome of delirium is better when the duration is shorter, it is important for clinicians to be sensitive to early symptoms so that treatment can be implemented faster, leading to less morbidity and mortality.
Similar content being viewed by others
References
Aakerland LP, Rosenberg J (1994) Postoperative delirium: treatment with supplementary oxygen. Br J Anaesth 72:286–290
Adams F, Fernandez F, Anderson B (1986) Emergency pharmacotherapy of delirium in the critically ill cancer patient. Psychosomatics 27:33–37
Asenbaum S, Deecke L, Zeitlhofer J (1992) Postoperative neuropsychiatric disorders and transitory syndromes. Internist 33:425–431
Bellani AE, Rodol'a F, Cannelli G, Barbi S (1991) Intravenous premedication with atropine and postanesthetic delirium. Report of two cases. Riv Fur Sci Med Farmacol 13:137–139
Burke AL, Diamond PL, Hulbert J, Yeatman J, Farr EA (1991) Terminal restlessness — its management and the role of midazolam. Med J Aust 155:485–487
Cole MG, Primeau FJ (1993) Prognosis of delirium in elderly hospital patients. Can Med Assoc J 149:41–46
Coyle N, Breitbart W, Weaver S, Portenoy R (1994) Delirium as a contributing factor to “crescendo” pain: three case reports. J Pain Symptom Manage 9:44–47
Craven JL (1990) Postoperative organic mental syndromes in lung transplant recipients. Toronto Lung Transplant Group. J Heart Transplant 9:1290–1292
Crippen DW (1990) The role of sedation in the ICU patient with pain and agitation. Crit Care Clin 6:369–392
Crippen DW (1994) Pharmacologic treatment of brain failure and delirium. Crit Care Clin 10:733–766
Cryns AG, Gorey KM, Goldstein MZ (1990) Effects of surgery on the mental status of older persons: a meta analytic review. J Geriatr Psychiatry Neurol 3:184–191
Danziger LH, Martin SJ, Blum RA (1994) Central nervous system toxicity associated with meperidine use in hepatic disease. Pharmacotherapy 14:235–238
Edwards G (1982) The treatment of drinking problems. Grant McIntyre, London
Fainsinger R, Bruera E (1992) Treatment of delirium in terminally ill patients (clinical conference). J Pain Symptom Manage 7:54–56
Fainsinger RL, Tapper M, Bruera E (1993) A perspective on the management of delirium in terminally ill patients on a palliative care unit. J Palliat Care 9:4–8
Fleishman S, Lesko LM (1990) Delirium and dementia. In: Holland JC, Rowland JH (eds) Handbook of psychooncology: psychological care of the patient with cancer. Oxford University Press, New York, pp 343–355
Freiberger JJ, Mariscano TH (1991) Alprazolam withdrawal presenting as delirium after cardiac surgery. J Cardiothoracic Vase Anesth 5:150–152
Goodwin DW (1989) Alcoholism. In: Kaplan HI, Sadock BJ (eds) Comprehensive textbook of psychiatry, 5th edn. Williams & Wilkins, Baltimore, pp 686–698
Hashimoto H, Yamashiro M (1994) Post-operative delirium and abnormal behavior related with pre-operative quality of life in elderly patients. Nippon Ronen Igakka Zasshi 31:633–638
Hese RT, Sikora G, Z'orawik M, Kotnis J (1991) What determines decreased mortality among patients treated for alcoholic delirium. Psychiatr Pol 25:50–55
Inouye SK, Viscoli CM, Horwitz RI, Hurst LD, Tinetti ME (1993) A predictive model for delirium in hospital ized elderly medical patients based on admission characteristics. Ann Intern Med 119:747–781
Johnson JC (1990) Delirium in the elderly. Emerg Med Clin North Am 8:255–265
Lesko LM, Fleishman S (1991) Treatment and support in confusional states. Recent Results Cancer Res 121:378–392
Levine RL (1994) Pharmacology of intravenous sedatives and opioids in critically ill patients. Crit Care Clin 10:709–731
Lipowski ZJ (1990) Delirium: acute confusional states. Oxford University Press, New York, pp 109–140
Marcantonio ER, Goldman L, Mangione CM, Ludwig LE, Muraca B, Haslauer CM, et al (1994) A clinical prediction rule for delirium after elective noncardiac surgery. JAMA 271:134–139
Marcantonio ER, Juarez G, Goldman L, Mangione CM, Ludwig LE, Lind L, et al (1994) The relationship of post operative delirium with psychoactive medications. JAMA 272:1518–1522
Mast RC van der, Fekkes D, Moleman P, Pepplinkhuizen L (1991) Is postoperative delirium related to re duced plasma tryptophan? Lancet 338:851–852
Menza M, Murray GB, Holmes VF, Rafuls WA (1987) Decreased extrapyramidal symptoms with intravenous haloperidol. J Clin Psychiatry 48:278–280
Meyers C, Scheibel R (1990) Early detection and diagnosis of neurobehavioral disorders associated with cancer and its treatment. Oncology 4:115–122
Naik P, Lawton J (1993) Pharmacological management of alcohol withdrawal. Br J Hosp Med 50:265–269
Olympio MA (1991) Postanesthetic delirium: historical perspectives. J Clin Anesth 3:60–63
Patchell R (1994) Neurological complications of organ transplantation. Ann Neurol 36:688–703
Platt MM, Breitbart W, Smith M, Marotta R, Weisman H, Jacobsen PB (1994) Efficacy of neuroleptics for hypoactive delirium (letter). J Neuropsychiatry Clin Neurosci 6:66–67
Rando EV (1990) Delirium in elderly cancer patients: nursing management. Dimens Oncol Nurs 4:5–8
Reyes RL, Bhattacharyya AK, Heller D (1981) Traumatic head injury: restlessness and agitation as prognosticators of physical and psychological improvement in patients. Arch Phys Med Rehabil 62:20–23
Rozner MA, Carson RC (1994) Preoperative prediction of postoperative delirium (letter). JAMA 271:1573
Sanders KM, Cassem EH (1993) Management of delirium associated with use of the intra-aortic balloon pump. Am J Crit Care 2:371–377
Sanders KM, Cassem EH (1993) Psychiatric complications in the critically ill cardiac patient. Texas Heart Inst J 20:180–187
Sanders KM, Murray GB, Cassem EH (1991) High-dose intravenous haloperidol for agitated delirium in a cardiac patient on intra-aortic balloon pump (letter). J Clin Psychopharmacol 11:146–147
Schor JD, Leukoff SE, Lipsitz LA, Reilly CH, Cleary PD, Rowe JW, et al (1992) Risk factors for delirium in hospitalized elderly. JAMA 267:827–831
Stiefel F, Holland J (1991) Delirium in cancer patients. Int Psychogeriatr 3:333–336
Stiefel F, Fainsinger R, Bruera E (1992) Acute confusional states in patients with advanced cancer. J Pain Symptom Manage 7:94–98
Tavani CA (1990) Perioperative psychiatric considerations in the elderly. Clin Geriatr Med 6:543–556
Taylor D, Lewis S (1993) Delirium: “neurological emergencies'”. J Neurol Neurosurg Psychiatry 56:742–751
Trzepacz P (1994) The neuropathogenesis of delirium, a need to focus our research. Psychosomatics 35:374–391
Trzepacz PT, Baker RW, Greenhouse J (1988) A symptom rating scale for delirium. Psychiatr Res 23:89–97
Trzepacz PT, Levenson JL, Tringali RA (1991) Psychopharmacology and neuropsychiatric syndromes in organ transplantation. Gen Hosp Psychiatry 13:233–245
Walley LT, Bradnock J (1990) Treatment of the classical manifestations of dementia and confusion. Br Med Bull 46:169–180
Weinrich S, Sarna L (1994) Delirium in the older person with cancer. Cancer 74 [Suppl]:7079–7091
William-Russo P, Urquhart BL, Sharrock NE, Charlson ME (1992) Postoperative delirium: predictors and prognosis in elderly orthopedic patients. J Am Geriatr Soc 40:759–767
Zimberg M, Berenson S (1990) Delirium in patients with cancer nursing assessment and intervention. Oncol Nurs Forum 19:529–538
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Olofsson, S.M., Weitzner, M.A., Valentine, A.D. et al. A retrospective study of the psychiatric management and outcome of delirium in the cancer patient. Support Care Cancer 4, 351–357 (1996). https://doi.org/10.1007/BF01788841
Issue Date:
DOI: https://doi.org/10.1007/BF01788841