Delirium in palliative medicine

an undisclosed companion of life in times when it is reaching its term

Abstract

Delirium is defined as an altered state of conscience and alertness. It encompasses a wide variety of symptoms from drowsiness to agitated hallucinations. Delirium is very frequent in terminal stage of cancer and is often overlooked. Misinterpretation of its symptoms and overtreatment may aggravate its severity. The causes are multiple and intertwined. Management of delirium includes non-pharmacological and pharmacological interventions with intent to reorient the patient if feasible, but mostly to prevent further anxiety, stress, and to improve his or her sleep. In some instances sedation of patient is necessary.

---

Povzetek

Delirij je definiran kot spremenjena stopnja zavesti in pozornosti. Vključuje širok razpon simptomov, od čezmerne zaspanosti do agitiranega haluciniranja. Čeprav gre za učinke več dejavnikov na isti sistem (živčevje), bi težko govorili le o enem kliničnem stanju. Delirij se pojavi pri skoraj vseh bolnikih v terminalni fazi in je pogosto spregledan. Napačno razlaganje (zamenjevanje za bolečino) in zdravljenje bolnikovih simptomov ga lahko še poslabšata (predoziranje zdravil). Vzroki so številni in največkrat prepleteni. Diferencialna diagnoza pogosto terja dodaten napor za razločevanje med podobnimi stanji. Zdravljenje vključuje nefarmakološke in farmakološke ukrepe, s kateri želimo bolnika znova orientirati, če je to smiselno, predvsem pa ublažiti prestrašenost in stisko, izboljšati spanje, v skrajnem primeru pa ga uspavati.