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Management of Delirium in Palliative Care: a Review

  • Complex Medical-Psychiatric Issues (MB Riba, Section Editor)
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Abstract

Delirium is a complex but common disorder in palliative care with a prevalence between 13 and 88 % but a particular frequency at the end of life (terminal delirium). By reviewing the most relevant studies (MEDLINE, EMBASE, PsycLit, PsycInfo, Cochrane Library), a correct assessment to make the diagnosis (e.g., DSM-5, delirium assessment tools), the identification of the possible etiological factors, and the application of multicomponent and integrated interventions were reported as the correct steps to effectively manage delirium in palliative care. In terms of medications, both conventional (e.g., haloperidol) and atypical antipsychotics (e.g., olanzapine, risperidone, quetiapine, aripiprazole) were shown to be equally effective in the treatment of delirium. No recommendation was possible in palliative care regarding the use of other drugs (e.g., α-2 receptors agonists, psychostimulants, cholinesterase inhibitors, melatonergic drugs). Non-pharmacological interventions (e.g., behavioral and educational) were also shown to be important in the management of delirium. More research is necessary to clarify how to more thoroughly manage delirium in palliative care.

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Acknowledgments

The staff of the Psycho-Oncology and Psychiatry in palliative care program at the University of Ferrara is acknowledged for their support

Compliance With Ethics Guidelines

ᅟ

Conflict of Interest

Luigi Grassi, Alex J Mitchell, Maria Giulia Nanni, Maria Alejandra Berardi, Rosangela Caruso, and Michelle Riba declare that they have no conflict of interest.

Augusto Caraceni has received board membership payments from Gruennethal and Pfizer; grants from Molteni, Gruenenthal, Prostrakan, Mundipharma, and Teva; and honoraria payments from Molteni.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

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Authors and Affiliations

  1. Institute of Psychiatry, Department of Biomedical and Specialty Surgical Sciences, University of Ferrara, Corso Giovecca 203, 44121, Ferrara, Italy

    Luigi Grassi, Maria Giulia Nanni & Rosangela Caruso

  2. University Hospital Psychiatry Unit, Program on Psycho-Oncology and Psychiatry in Palliative Care, S. Anna University Hospital and Health Authorities, Ferrara, Italy

    Luigi Grassi, Maria Giulia Nanni & Rosangela Caruso

  3. Palliative Care, Pain Therapy and Rehabilitation Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy

    Augusto Caraceni

  4. European Palliative Care Research Center, Norwegian University of Science and Technology, Trondheim, Norway

    Augusto Caraceni

  5. Department of Psycho-Oncology, Cancer Studies and Molecular Medicine, University of Leicester, Leicester, UK

    Alex J. Mitchell

  6. Psycho-Oncology Unit, Istituto Scientifico per lo Studio e la Cura dei Tumori (IRST) S.r.l., IRCCS, Meldola, FC, Italy

    Maria Alejandra Berardi

  7. Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA

    Michelle Riba

  8. University of Michigan Comprehensive Depression Center, Ann Arbor, MI, USA

    Michelle Riba

  9. Psycho-Oncology Program, University of Michigan Comprehensive Cancer Center, Ann Arbor, MI, USA

    Michelle Riba

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  1. Luigi Grassi
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Correspondence to Luigi Grassi.

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This article is part of the Topical Collection on Complex Medical-Psychiatric Issues

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Grassi, L., Caraceni, A., Mitchell, A.J. et al. Management of Delirium in Palliative Care: a Review. Curr Psychiatry Rep 17, 13 (2015). https://doi.org/10.1007/s11920-015-0550-8

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  • DOI: https://doi.org/10.1007/s11920-015-0550-8

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