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Should neuroleptics be used in patients with delirium seen by palliative care?

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    David Hui
    Correspondence
    Corresponding author: David Hui, MD, MSc, Department of Palliative Care, Rehabilitation and Integrative Medicine, Unit 1414 - University of Texas MD Anderson Cancer Centre, 1515 Holcombe Boulevard, Houston, TX, USA 77030. Phone: 713-745-7082; Fax: 713-792-6092
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    Affiliations
    Department of Palliative Care, Rehabilitation and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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    Meera Agar
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    IMPACCT Centre, University of Technology Sydney, Sydney, Australia
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    Isseki Maeda
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    Affiliations
    Department of Palliative Care, Senri-Chuo Hospital, Osaka, Japan
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      Abstract

      Delirium commonly occurs in the palliative care setting and impacts many aspects of patient care, such as symptom assessment, patient-clinician communication, and medical decision-making. One controversial topic regarding the management of delirium in the palliative care setting is whether neuroleptics should be used. In this “Controversies in Palliative Care” article, 3 expert clinicians independently answer this question. Specifically, each group provides a synopsis of the key studies that inform their thought processes, share practical advice on their clinical approach, and highlight the opportunities for future research. Interestingly, all 3 experts arrived at similar conclusions—they underscored the importance of identification and treatment of any reversible causes of delirium and endorsed a trial of non-pharmacologic measures. They also agreed that neuroleptics should be considered for patients with hyperactive or mixed delirium when the conservative measures fail to control delirium symptoms and for delirious patients with days of life expectancy and thus limited time to try other measures. Risk of adverse effects such as extrapyramidal symptoms and seizures should be considered as part of the treatment decision. There is also a need to conduct high quality research to examine both neuroleptics and neuroleptic-sparing strategies for the management of delirium.

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