RETROSPECTIVE STUDY OF THE PSYCHIATRIC MANAGEMENT AND OUTCOME OF DELIRIUM IN THE CANCER-PATIENT

This report describes the evaluation and treatment of delirium in the cancer patient in a major comprehensive cancer center. Ninety consecut ive cases of delirium seen by the inpatient psychiatry consultation/li aison service were analyzed in a retrospective fashion to evaluate dem ographic information, alcohol use, central nervous system disease, coe xisting 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, dur ation of delirium, outcome, and the venue where the delirium began wer e also evaluated. The hyperal ert subtype of delirium was the commones t type observed (71%) and had the shortest duration (P<0.0001) and bes t outcome (P<0.001). The patients with a hyperalert delirium subtype w ere treated with the least amount of haloperidol (P<0.0001). Patients were delirious for longer when the delirium began in the intensive-car e units (P<0.04). In general, patients who received no haloperidol exp erienced delirium of longer duration (P<0.02) than those receiving hal operidol. Since the data represent patients who were referred for psyc hiatric treatment, this may explain the increased number of hyperalert deliriums and, therefore, the generalizability of the results is limi ted. 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 imp ortant for clinicians to be sensitive to early symptoms so that treatm ent can be implemented faster, leading to less morbidity and mortality .