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Confusion and Delirium

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Cancer Neurology in Clinical Practice

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Abstract

Delirium is one of the most frequent neurological complications occurring in patients with cancer, ranking second after pain among the reasons for requesting a neurological consult at a tertiary cancer center (1). Inappropriate behavior, cognitive disturbance, and lack of judgment can be distressing for patients and families and impact upon attempts to deliver optimal medical care. In addition, delirium is usually a sign of the presence of significant medical complications and is associated with increased mortality. The signs and symptoms of this disorder are diverse and maybe mistaken for other psychiatric disorders including mood and anxiety disorders. Different terms have been used to denote delirium over the years, including confusion, acute confusional states, acute brain failure, acute dementia, acute organic syndrome, cerebral insufficiency, metabolic encephalopathy, organic brain syndrome, reversible toxic psychosis, and intensive care unit psychosis (2). This inconsistent terminology has contributed to the insufficient understanding of delirium in clinical and research settings (2). This chapter will describe the terminology used for delirium, the symptoms that characterize the condition and its diagnosis, etiologic factors, treatment, and prognosis.

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References

  1. Clouston PD, DeAngelis L, Posner JB. The spectrum of neurological disease in patients with systemic cancer. Ann Neurol 1992; 31: 268–273.

    Article  PubMed  CAS  Google Scholar 

  2. Lipowski ZJ. Delirium: Acute Confusional States. Oxford University Press, New York, 1990.

    Google Scholar 

  3. Hippocrates with an English translation by WHS Jones. William Heinemann LTD, London, 1931.

    Google Scholar 

  4. Berrios GE. Delirium and confusion in the 19th century. A conceptual history. Br J Psychiatry 1981; 139: 439–449.

    Article  PubMed  CAS  Google Scholar 

  5. Steinberg D. What modern neuroscience can learn from Hughling Jackson. In: A Short History of Neurology. Clifford Rose F, ed. Buttherworth Heinemann, Oxford, 1999, pp. 165–177.

    Google Scholar 

  6. Mesulam M-M. Attention, confusional states, and neglect. In: Principles of Behavioral Neurology. Mesulam MM, ed. F.A. Davis, Philadelphia, 1985, pp. 125–168.

    Google Scholar 

  7. Plum F, Posner JB. The diagnosis of stupor and coma. F.A. Davis, Philadelphia, 1980.

    Google Scholar 

  8. Adams RD, Victor M. Principles of Neurology, 6th ed. McGraw-Hill, New York, 1997.

    Google Scholar 

  9. Engel GL, Romano J. Delirium a syndrome of cerebral insufficiency. J Chronic Dis 1959; 9: 260–277.

    Article  PubMed  CAS  Google Scholar 

  10. American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders. Third Edition Revised. American Psychiatry Association, Washington, DC, 1987.

    Google Scholar 

  11. American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition. American Psychiatric Association, Washington, DC, 1994.

    Google Scholar 

  12. World Health Organization. The ICD-10 Classification of Mental and Behavioral Disorders: Clinical Descriptions and Diagnostic Guidelines. WHO Publications, Geneva, 1992.

    Google Scholar 

  13. Ross CA. Etiological models and their phenomenological variants. CNS arousal systems: possible role in delirium. Intl Psychogeriatr 1991; 3 (2): 353–371.

    Article  CAS  Google Scholar 

  14. Trzepacz PT. Update on the neuropathogenesis of delirium. Dement Geriatr Cogn Disord 1999; 10: 330–334.

    Google Scholar 

  15. Moruzzi G, Magoun HW. Brain stem reticular formation and activation of the EEG. Electroenceph Clin Neurophysiol 1949; 1: 455–473.

    PubMed  CAS  Google Scholar 

  16. Perry E, Walker M, Grace J, Perry R. Acetylcholine in mind: a neurotransmitter correlate of consciousness. Trends Neurosci 1999; 22 (6): 273–280.

    Article  PubMed  CAS  Google Scholar 

  17. Fukutani Y, Katsukawa K, Matsubara R, Kobayashi K, Nakamura I, Yamaguchi N. Delirium associated with Joseph disease. J Neurol Neurosurg Psychiatry 1993; 56 (11): 1207–1212.

    Article  PubMed  CAS  Google Scholar 

  18. Mesulam MM, Waxman SG, Geschwind N, Sabin TD. Acute confusional state with right cerebral artery infarction. J Neurol Neurosurg Psychiatry 1976; 39: 84–89.

    Article  PubMed  CAS  Google Scholar 

  19. Kaufer D, Catt K, Lopez O, De KS. Dementia with Lewy bodies: response of delirium-like features to donepezil. Neurology 1998; 51 (5): 1512.

    Article  PubMed  CAS  Google Scholar 

  20. Blass JP, Gibson GE. Cerebromeabolic aspects of delirium in relationship to dementia. Dement GeriatrCognDisord 1999; 10: 335–338.

    Article  CAS  Google Scholar 

  21. Gibson GE, Blass JP, Huang H, Freeman GB. The cellular basis of delirium and its relevance to age-related disorders including Alzheimer disease. Intl Psychogeriatr 1991; 3 (2): 373–395.

    Article  CAS  Google Scholar 

  22. Stefano GB, Bilfinger TV, Fricchione GL. The immune neuro-link and the macrophage: postcardiotomy delirium, HIV associate dementia and psychiatry. Prog Neurobiol 1994; 42 (4): 475–488.

    Article  PubMed  CAS  Google Scholar 

  23. Flacker JM, Lipsitz LA. Serum anticholinergic activity changes with acute illness in elderly medical patients. J Gerontol MS 1999; 54A: M 12-M 16.

    Google Scholar 

  24. Barbato M, Rodriguez PJ. Thiamine deficiency in patients admitted to a palliative care unit. Pall Med 1994; 8: 320–324.

    Article  CAS  Google Scholar 

  25. O’Keeffe ST, Tormey WP, Glasgow R, Lavan JN. Thiamine deficiency in hospitalized elderly patients. Gerontology 1994; 40 (1): 18–24.

    Article  PubMed  Google Scholar 

  26. Papersack T, Garbusinski J, Robberecht J, Beyer I, Willems D, Fuss M. Clinical relevance of thiamine status amongst hospitalized elderly patients. Gerontology 1999; 45: 96–101.

    Article  Google Scholar 

  27. Flacker JM, Lipsitz LA. Neural mechanisms of delirium: current hypotheses and evolving concepts. J Gerontol Biol Sci 1999; 54A: B239 - B246.

    Article  CAS  Google Scholar 

  28. Trzepacz PT. The neuropathogenesis of delirium. A need to focus our research. Psychosomatics 1994; 35: 374–391.

    Article  PubMed  CAS  Google Scholar 

  29. Erkinjutti T, Wikstrom J, Palo J, Autio K. Dementia among medical inpatients. Evaluation of 2000 consecutive admission. Arch Intern Med 1986; 146: 1923–1926.

    Article  Google Scholar 

  30. Minagawa H, Yosuke U, Yamawaki S, Ishitani K. Psychiatric morbidity in terminally ill cancer patients. Cancer 1996; 78: 1131–1137.

    Article  PubMed  CAS  Google Scholar 

  31. Lawlor PG, Gagnon B, Mancini IL, Pereira JL, Hanson J, SuarezAlmazor ME, Bruera ED. Occurrence, causes and outcome of delirium in patients with advanced cancer. Arch Intern Med 2000; 160: 786–794.

    Article  PubMed  CAS  Google Scholar 

  32. Caraceni A, Nanni O, Maltoni M, Piva L, Indelli M, Arnoldi E, et al. Italian Multicenter Study Group on Palliative Care. The impact of delirium on the short-term prognosis of advanced cancer patients. Cancer 2000; 89: 1145–1149.

    Article  PubMed  CAS  Google Scholar 

  33. Gagnon P, Allard P, Masse B, DeSerres M. Delirium in terminal cancer: a prospective study using daily screening, early diagnosis and continuous monitoring. J Pain Sympt Management 2000: 19 (6): 412–426.

    Article  CAS  Google Scholar 

  34. Liptzin B, Levkoff SE, Cleary PD, Pilgrim DM, Reilly CH, Albert M, Wetle TW. An empirical study of diagnostic criteria for delirium. Am J Psychiatry 1991; 148(4): 451 157.

    Google Scholar 

  35. Lewis LM, Miller DK, Morley JE, Nork MJ, Lasater LC. Unrecognized delirium in ED geriatric patients. Am J Emerg Med 1995; 13 (2): 142–145.

    Article  PubMed  CAS  Google Scholar 

  36. Wolf HG, Curran D. Nature of delirium and allied states. The disergastic reaction. Arch Neurol Psychiatry 1935; 33: 1175–1215.

    Article  Google Scholar 

  37. Liptzin B, Levkoff SE. An empyrical study of delirium subtypes. Br J Psychiatry 1992; 161: 843–845.

    Article  PubMed  CAS  Google Scholar 

  38. Chedru F, Geschwind N. Writing disturbances in acute confusional state. Neuropsychologia 1972; 10: 343–353.

    Article  PubMed  CAS  Google Scholar 

  39. Macleod AD, Whitehead LE. Dysgraphia in terminal delirium. Palliat Med 1997; 11: 127–132.

    Article  PubMed  CAS  Google Scholar 

  40. Inouye SK. The dilemma of delirium: clinical and research controveries regarding diagnosis and evaluation of delirium in hospitalized elderly medical patients. Am J Med 1994; 97: 278–288.

    Article  PubMed  CAS  Google Scholar 

  41. Smith MJ, Breitbart WS, Platt MM. A critique of instruments and methods to detect, diagnose, and rate delirium. J Pain Sympt Manage 1994; 10: 35–77.

    Article  Google Scholar 

  42. Inouye SK, van Dyck CH, Alessi CA, Balkin S, Siegal AP, Horwitz RI. Clarifying confusion: the confusion assessment method. A new method for detection of delirium. Ann Intern Med 1990; 113 (12): 941–948.

    Article  PubMed  CAS  Google Scholar 

  43. Zou Y, Cole M, Primeau F, McCusker J, Bellavance F, Laplante J. Detection and diagnosis of delirium in the elderly: psychiatrist diagnosis, confusion assessment method, or consensus diagnosis? Intl Psychogeriatr 1998; 10 (3): 303–308.

    Article  CAS  Google Scholar 

  44. Trzepacz PT, Baker RW, Greenhouse J. A symptom rating scale for delirium. Psychiatry Res 1988; 23: 89–97.

    Article  PubMed  CAS  Google Scholar 

  45. Breitbart W, Rosenfeld B, Roth A, Smith MJ, Cohen K, Passik S. The memorial delirium assessment scale. J Pain Symptom Management 1997; 13: 128–137.

    Article  CAS  Google Scholar 

  46. Robertsson B, Karlsson I, Styrud E, Gottfries C. Confusional State Evaluation (CSE): an instrument for measuring severity of delirium in the elderly. Br J Psychiatry 1997; 170: 565–570.

    Article  PubMed  CAS  Google Scholar 

  47. McCusker J, Cole M, Bellavance F, Primeau F. Reliability and validity of a new measure of severity of delirium. Intl Psychogeriatr 1998; 10 (4): 421–433.

    Article  CAS  Google Scholar 

  48. Pompei P, Foreman M, Cassel C, Alessi C, Cox D. Detecting delirium among hospitalized older patients. Arch Intern Med 1995; 155: 301–307.

    Article  PubMed  CAS  Google Scholar 

  49. Rockwood K, Gocedman J, Flynn M, Stolee P. Cross-validation of the delirium rating scale in older patients. J Am Geriatr Soc 1996; 44: 839–842.

    PubMed  CAS  Google Scholar 

  50. Grassi L, Caraceni A, Beltrami E, Zamorani M, Maltoni M, Monti M, et al. Assessing delirium in cancer patients the Italian versions of the Delirium Rating Scale and the Memorial Delirium Assessment Scale. J Pain Sympt Management 2001; 21 (1): 59–68.

    Article  CAS  Google Scholar 

  51. Trzepacz PT, Brenner RP, Coffman GC, van Thiel DH. Delirium in liver transplantation candidates: discriminant analysis of multiple test variables. Biol Psychiatry 1988; 24: 3–15.

    Article  PubMed  CAS  Google Scholar 

  52. Jacobson SA, Leuchter AF, Walter DO. Conventional and quantitative EEG in the diagnosis of delirium among the elderly. J Neurol Neurosurg Psychiatry 1993; 56: 153–158.

    Article  PubMed  CAS  Google Scholar 

  53. Young GB, Leung LS, Campbell V, DeMelo J, Schieven J, Tilsworth R. The electroencephalogram in metabolic/toxic coma. Am J EEG Technol 1992; 32: 243–259.

    Google Scholar 

  54. Wengs WJ, Talwar D, Bernard J. Ifosfamide-induced nonconvulsive status epilepticus. Arch Neurol 1993; 50: 1104–1105.

    Article  PubMed  CAS  Google Scholar 

  55. Schmidley JW, Messing RO. Agitated confusional states in patients with right hemispere infarctions. Stroke 1984; 5: 883–885.

    Article  Google Scholar 

  56. Mori E, Yamadori A. Acute confusional state and acute agitated delirium. Occurrence after infarction in the right middle cerebral artery territory. Arch Neurol 1987; 44: 1139–1143.

    Article  PubMed  CAS  Google Scholar 

  57. Henon H, Lebert F, Durieu I, Godefroy O, Lucas C, Pasquier F, Leys D. Confusional state in stroke. Relation to preexisting dementia, patient characteristics and outcome. Stroke 1999; 30: 773–779.

    Article  PubMed  CAS  Google Scholar 

  58. Wasserstrom WR, Glass JP, Posner JB. Diagnosis and treatment of leptomeningeal metastasis from solid tumors: experience with 90 patients. Cancer 1982; 49: 759–772.

    Article  PubMed  CAS  Google Scholar 

  59. Posner JB. Neurologic Complications of Cancer. F.A. Davis, Philadelphia, 1995.

    Google Scholar 

  60. Formaglio F, Caraceni A. Meningeal metastases clinical aspects and diagnosis. Ital J Neurol Sci 1998; 19: 133–149.

    Article  PubMed  CAS  Google Scholar 

  61. Weitzener MA, Olofson SM, Forman AD. Patients with malignant meningitis presenting with neuropsychiatric manifestations. Cancer 1995; 76: 1804–1808.

    Article  Google Scholar 

  62. Grossman SA, Trump DL, Chen DCP, Thomson G, Camargo EE. Cerebrospinal fluid abnormalities in patients with neoplastic meningitis. Am J Med 1982; 73: 641–647.

    Article  PubMed  CAS  Google Scholar 

  63. Trzepacz P, Ho V, Mallavarapu H. Cholinergic delirium and neurotoxicity associated with tacrine for Alzheimer’ s dementia. Psychosomatics 1996; 37 (3): 299–301.

    Article  PubMed  CAS  Google Scholar 

  64. Bruera E, Macmillan K, Hanson J, MacDonald RN. The cognitive effects of the administration of narcotic analgesics in patients with cancer pain. Pain 1989; 39 (1): 13–16.

    Article  PubMed  CAS  Google Scholar 

  65. Zacny JP. A review of the effects of opioids on psychomotor and cognitive functioning in humans. Exp Clin Psychopharmacol 1995; 3 (4): 432–466.

    Article  CAS  Google Scholar 

  66. Sjogren P, Olsen AK, Thomsen AB, Dalberg J. Neuropsychological performance in cancer patients: the role of oral opioids, pain and performance status. Pain 2000; 86 (3): 237–245.

    Article  PubMed  CAS  Google Scholar 

  67. JellemaJG. Hallucinations during sustained-release morphine and methadone administration. Lancet 1987; i: 392.

    Google Scholar 

  68. Caraceni A, Martini C, De Conno F, Ventafridda V. Organic brain syndromes and opioid administration for cancer pain. J Pain Sympt Management 1994; 9 (8): 527–533.

    Article  CAS  Google Scholar 

  69. Sjogren P, Jonsson T, Jensen NH, Drenck NE, Jensen TS. Hyperalgesia and myoclonus in terminal cancer patients treated with continuous intravenous morphine. Pain 1993; 55 (1): 93–97.

    Article  PubMed  CAS  Google Scholar 

  70. Hagen N, Swanson R. Strychnine-like multifocal myoclonus and seizures in extremely high-dose opioid administration: treatment strategies. J Pain Sympt Management 1997; 14: 51–58.

    Article  CAS  Google Scholar 

  71. Francis J, Martin D, Kapoor WN. A prospective study of delirium in hospitalized elderly. JAMA 1990; 263: 1097–1101.

    Article  PubMed  CAS  Google Scholar 

  72. Schor JD, Levkoff SE, Lipsitz LA, Reilly CH, Cleary PD, Rowe JW, Evans DA. Risk factors for delirium in hospitalized elderly. JAMA 1992; 267 (6): 827–831.

    Article  PubMed  CAS  Google Scholar 

  73. Inouye SK, Viscoli CM, Horwitz RI, Hurst LD, Tinetti ME. A predictive model for delirium in hospitalized elderly medical patients based on admission characteristics. Ann Intern Med 1993; 119 (6): 474–481.

    Article  PubMed  CAS  Google Scholar 

  74. Ferguson JA, Suelzer CJ, Eckert GJ, Zhou XH, Dittus RS. Risk factors for delirium tremens development. J Gen Intern Med 1996; 11 (7): 410–414.

    Article  PubMed  CAS  Google Scholar 

  75. Inouye SK, Charpentier PA. Precipitating factors for delirium in hospitalized elderly persons. Predictive model and interrelationship with baseline vulnerability. JAMA 1996; 275 (11): 852–857.

    Article  PubMed  CAS  Google Scholar 

  76. Inouye SK, Bogardus ST, Charpentier PA, Leo-Summers L, Acampora D, Holford TR, Coeney LM. A multicomponent intervention to prevent delirium in hospitalized older patients. N Engl J Med 1999; 340 (9): 669–676.

    Article  PubMed  CAS  Google Scholar 

  77. Tuma R, DeAngelis LM. Altered mental status in patients with cancer. Arch Neurol 2000; 57 (12): 1727–1731.

    Article  PubMed  CAS  Google Scholar 

  78. Turner RK, Lichstein PR, Peden JG, Busher JT, Waivers LE. Alcohol withdrawal syndromes: a review of pathophysiology, clinical presentation and treatment. J Gen Intern Med 1989; 4: 432–443.

    Article  PubMed  CAS  Google Scholar 

  79. Seibert CP. Recognition, management and prevention of neuropsychological dysfunction after operation. Int Anesth Clinic 1986; 24: 39–58.

    Article  CAS  Google Scholar 

  80. Smith LW, Dinsdale JE. Postcardiotomy delirium: conclusions after 25 years. Am J Psychiatry 1989; 146 (4): 452–458.

    PubMed  CAS  Google Scholar 

  81. Berggren D, Gustafson Y, Erikson B, Bucht G, Hansson L, Reiz S, Winblad B. Postoperative confusion in elderly patients with femoral neck fractures. Anesth Analg 1987; 66: 497–504.

    Article  PubMed  CAS  Google Scholar 

  82. O’Keeffe ST, Chonchubhair A. Postoperative delirium in the elderly. Br J Anaesth 1995; 73 (5): 673–687.

    Article  Google Scholar 

  83. Marcantonio ER, Goldman L, Mangione CM, Ludwig LE, Muraca B, Haslauer CM, et al. A clinical prediction rule for delirium after elective noncardiac surgery. JAMA 1994; 271 (2): 134–139.

    Article  PubMed  CAS  Google Scholar 

  84. Marcantonio ER, Juarez G, Goldman L, Mangione CM, Ludwig LE, Lind L, et al. The relationship of postoperative delirium with psychoactive medication. JAMA 1994; 272: 1518–1522.

    Article  PubMed  CAS  Google Scholar 

  85. Marcantonio ER, Goldman L, Orav EJ, Cook EF, Lee TH. The association of intraoperative factors with the development of postoperative delirium. Am J Med 1998; 105 (11): 380–384.

    Article  PubMed  CAS  Google Scholar 

  86. O’Keeffe ST. Clinical subtypes of delirium in the elderly. Dement Geriatr Cogn Disord 1999; 10: 380–385.

    Article  PubMed  Google Scholar 

  87. Francis J, Kapoor WN. Prognosis after hospital discharge of older medical patients with delirium. J Am Geriatr Soc 1992; 40: 601–606.

    PubMed  CAS  Google Scholar 

  88. Carlson LA, Gottfries CG, Winbland B, Robertson B, eds. Delirium in the elderly. Epidemiological, pathogenetic and treatment aspects. Dement Geriatr Cog Disord 1999; 10(5): 306–429.

    Google Scholar 

  89. Farrell KR, Ganzini L Misdiagnosing delirium as depression in medically ill elderly patients. Arch Intern Med 1995; 155: 2459–2464.

    Article  PubMed  CAS  Google Scholar 

  90. Morita T, Tsunoda J, Inoue S, Chihara S. The palliative prognostic index: a scoring system for survival prediction of terminally ill cancer patients. Support Care Cancer 1999; 7 (3): 128–133.

    Article  PubMed  CAS  Google Scholar 

  91. Ripamonti C, Bruera E. CNS adverse effects of opioids in cancer patients. Guidelines for treatment. CNS Drugs 1997; 8 (1): 21–37.

    CAS  Google Scholar 

  92. Bruera E, Fainsinger RL, Miller MJ, Kuehn N. The assessment of pain intensity in patients with cognitive failure: a preliminary report. J Pain Sympt Management 1992; 7 (5): 267–270.

    Article  CAS  Google Scholar 

  93. Cherny NI, Coyle N, Foley KM. Suffering in the advanced cancer patient: a definition and taxonomy. J Palliative Care 1994; 10 (2): 57–70.

    CAS  Google Scholar 

  94. American Psychiatric Association. Practice guideline for the treatment of patients with delirium. Am J Psychiatry 1999; 156 (5 Suppl): 1–20. http://www.psych.org

    Google Scholar 

  95. Liptzin B. Delirium. In: Comprehensive Review of Geriatric Psychiatry, 2nd ed. Sadavoy J, Lazarus L, Jarvik L, Grossberg G, eds. American Psychiatric Press, Washington, DC, 1996, pp. 479–495.

    Google Scholar 

  96. Shapiro BA, Warren J, Egol AB, Greenbaum DM, Jacobi J, Nasraway SA, et al. Practice parameters for intravenous analgesia and sedation for adult patients in the intensive care unit: an executive summary. Society of Critical Care Medicine [see comments]. Crit Care Med 1995; 23 (9): 1596–1600.

    Article  PubMed  CAS  Google Scholar 

  97. Levenson JL. High-dose intravenous haloperidol for agitated delirium following lung transplantation. Psychosomatics 1995; 36 (1): 66–68.

    Article  PubMed  CAS  Google Scholar 

  98. Tesar GE, Murray GB, Cassem NH. Use of high-dose intravenous haloperidol in the treatment of agitated cardiac patients. J Clin Psychopharmacol 1985; 5 (6): 344–347.

    PubMed  CAS  Google Scholar 

  99. Riker RR, Fraser GL, Cox PM. Continuous infusion of haloperidol controls agitation in critically ill patients. Crit Care Med 1994; 22: 433–440.

    Article  PubMed  CAS  Google Scholar 

  100. Frye MA, Coudreaut MF, Hakeman SM, Shah BG, Strouse TB, Skotzko CE. Continuous droperidol infusion for management of agitated delirium in an intensive care unit. Psychosomatics 1995; 36 (3): 301–305.

    Article  PubMed  CAS  Google Scholar 

  101. Hunt N, Stern TA. The association between intravenous haloperidol and torsades de pointes. Psychosomatics 1995; 36 (6): 541–549.

    Article  PubMed  CAS  Google Scholar 

  102. DiS alvo TG, O’Gara PT. Torsade de pointes caused by high dose intravenous haloperidol in cardiac patients. Clin Cardiol 1995; 18: 285–290.

    Article  PubMed  Google Scholar 

  103. Wilt JL, Minnema AM, Johnson RF, Rosenblum AM. Torsade de pointes associated with the use of intravenous haloperidol. Ann Intern Med 1993; 119 (5): 391–394.

    Article  PubMed  CAS  Google Scholar 

  104. Jackson T, Ditmanson L, Phibbs B. Torsade de pointes and low-dose oral haloperidol. Arch Intern Med 1997; 157 (17): 2013–2015.

    Article  PubMed  CAS  Google Scholar 

  105. Sharma ND, Rosman HS, Padhi ID, Tisdale JE. Torsades de pointes associated with intravenous haloperidol in critically ill patients. Am J Cardiol 1998; 81 (2): 238–240.

    Article  PubMed  CAS  Google Scholar 

  106. Thomas H, Schwartz E, Petrilli R. Droperidol versus haloperidol for chemical restraint of agitated and combative patients. Ann Emerg Med 1992; 21: 407–413.

    Article  PubMed  Google Scholar 

  107. Passik SD, Cooper M. Complicated delirium in a cancer patient successfully treated with olanzapine. J Pain Sympt Management 1999; 17 (3): 219–223.

    Article  CAS  Google Scholar 

  108. Newman JP, Terris DJ, Moore M. Trends in the management of alcohol withdrawal syndrome. Laryngoscope 1995; 105 (1): 1–7.

    Article  PubMed  CAS  Google Scholar 

  109. Fernandez F, Holmes VF, Adams F, Kavanaugh JJ. Treatment of severe refractory agitation with haloperidol drip. J Clin Psychiatry 1988; 49: 239–241.

    PubMed  CAS  Google Scholar 

  110. Fernandez F, Levy JK, Mansell PW. Management of delirium in terminally ill AIDS patients. Int J Psychiatry Med 1989; 19(2): 165172.

    Google Scholar 

  111. Stiefel F, Fainsinger R, Bruera E. Acute confusional states in patients with advanced cancer. J Pain Sympt Management 1992; 7(2): 94–98.

    Google Scholar 

  112. Breitbart W, Marotta R, Platt MM, Weisman H, Derevenco M, Grau C. A double-blind trial of haloperidol, chlorpromazine and lorazepam in the treatment of delirium in hospitalized AIDS patients. Am J Psychiatry 1996; 153: 231–237.

    PubMed  CAS  Google Scholar 

  113. Bottomley D, Hanks G. Subcutaneous midazolam infusion in palliative care. J Pain Sympt Management 1990; 5 (4): 259–261.

    Article  CAS  Google Scholar 

  114. Burke AL, Diamond PL, Hulbert J, Yeatman J, Farr EA. Terminal restlessness-its management and the role of midazolam. Med J Aust 1991; 155 (7): 485–487.

    PubMed  CAS  Google Scholar 

  115. Burke AL. Palliative care: an update on “terminal restlessness. Med J Aust 1997; 166: 39–42.

    PubMed  CAS  Google Scholar 

  116. Burns MJ, Linden CH, Graudins A, Brown RM, Fletcher KE. A comparison of physostigmine and benzodiazepines for the treatment of anticholinergic poisoning. Ann Emerg Med 2000; 35 (4): 374–381.

    Article  PubMed  CAS  Google Scholar 

  117. Slatkin NE, Rhiner M, Bolton TM. Donezepil in the treatment of opiate induced sedation. J Pain Sympt Management 2001; 21: 425–438.

    Article  CAS  Google Scholar 

  118. Morita T, Otani H, Tsunoda J, Inoue S, Chihara S. Succesful palliation of hypoactive delirium due to multiorgan failure by oral methylphenidate. Supp Care Cancer 2000; 8 (2): 134–137.

    Article  CAS  Google Scholar 

  119. Levenson JA. Should psychostimulants be used to treat delirious patients with depressed mood. J Clin Psychiatry 1992; 53 (2): 69.

    PubMed  CAS  Google Scholar 

  120. Koponen HJ, Riekkinen PJ. A prospective study of delirium in elderly patients admitted to a psychiatric hospital. Psychol Med 1993; 23: 103–109.

    Article  PubMed  CAS  Google Scholar 

  121. Levkoff SE, Evans DA, Lipzin B, Cleary PD, Lipsitz LA, Wetle TT, et al. Delirium. The occurence and persistence of symptoms among elderly hospitalized patients. Arch Intern Med 1992; 152: 334–340.

    Article  PubMed  CAS  Google Scholar 

  122. van Hemert AM, van der Mast RC, Hengeveld MW, Vorstenbosch M. Excess mortality in general hospital patients with delirium: a 5-year follow-up of 519 patients seen in psychiatric consultation. J Psychosomatic Res 1994; 38 (4): 339–346.

    Article  Google Scholar 

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Authors
  1. Augusto Caraceni MD
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  2. Marco Bosisio PhD
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  3. Jane M. Ingham MB, BS, FRACP
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Editors and Affiliations

  1. Department of Neurology, University of Virginia Medical Center, Charlottesville, VA, USA

    David Schiff MD

  2. Center for Neuro-Oncology Dana-Farber Cancer Institute; and Department of Neurology, Brigham and Women’s Hospital, Boston, MA, USA

    Patrick Y. Wen MD

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Caraceni, A., Bosisio, M., Ingham, J.M. (2003). Confusion and Delirium. In: Schiff, D., Wen, P.Y. (eds) Cancer Neurology in Clinical Practice. Humana Press, Totowa, NJ. https://doi.org/10.1007/978-1-59259-317-0_5

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