Safety and effectiveness of antipsychotic medication for delirium in patients with advanced cancer: A large-scale multicenter prospective observational study in real-world palliative care settings

被引：21

作者：

Maeda, Isseki ^{[1
]}

Ogawa, Asao ^{[2
]}

Yoshiuchi, Kazuhiro ^{[3
]}

Akechi, Tatsuo ^{[4
,5
]}

Morita, Tatsuya ^{[6
,7
]}

Oyamada, Shunsuke ^{[8
]}

Yamaguchi, Takuhiro ^{[9
]}

Imai, Kengo ^{[7
]}

Sakashita, Akihiro ^{[10
]}

Matsumoto, Yoshihisa ^{[11
]}

Uemura, Keiichi ^{[12
]}

Nakahara, Rika ^{[13
]}

Iwase, Satoru ^{[14
]}

机构：

[1] Senri Chuo Hosp, Dept Palliat Care, 1-4-3 Shin Senri Higashi Machi, Toyonaka, Osaka, Japan

[2] Natl Canc Ctr Hosp East, Dept Psycho Oncol Serv, 6-5-1 Kashiwa No Ha, Kashiwa, Chiba, Japan

[3] Univ Tokyo, Grad Sch Med, Dept Stress Sci & Psychosomat Med, Bunkyo Ku, 7-3-1 Hongo, Tokyo, Japan

[4] Nagoya City Univ Hosp, Div Psychooncol & Palliat Care, Nagoya, Aichi, Japan

[5] Nagoya City Univ, Dept Psychiat & Cognit Behav Med, Grad Sch Med Sci, Mizuho Ku, Kawasumi 1,Mizuho Cho, Nagoya, Aichi, Japan

[6] Seirei Mikatahara Gen Hosp, Palliat Care Team, Dept Palliat & Support Care, Kita Ku, 3453 Mikatahara Cho, Hamamatsu, Shizuoka, Japan

[7] Seirei Mikatahara Gen Hosp, Seirei Hosp, Kita Ku, 3453 Mikatahara Cho, Hamamatsu, Shizuoka, Japan

[8] JORTC Data Ctr, Dept Biostat, Arakawa Ku, KS Bldg 301, Tokyo, Japan

[9] Tohoku Univ, Sch Med, Div Biostat, Aoba Ku, 2-1 Seiryo Cho, Sendai, Miyagi, Japan

[10] Kobe Univ, Dept Palliat Med, Grad Sch Med, 7-5-1 Kusunoki Cho, Kobe, Hyogo, Japan

[11] Natl Canc Ctr Hosp East, Dept Palliat Med, 6-5-1 Kashiwa No Ha, Kashiwa, Chiba, Japan

[12] Tonan Hosp, Dept Psychiat, Chuo Ku, 3-8 Kita 4Jo,Nishi 7Jo, Sapporo, Hokkaido, Japan

[13] Natl Canc Ctr, Dept Psychooncol, Chuo Ku, 5-1-1 Tsukiji, Tokyo, Japan

[14] Saitama Med Univ, Dept Palliat Med, 38 Moroyama Hongo, Iruma, Saitama, Japan

来源：

GENERAL HOSPITAL PSYCHIATRY | 2020年 / 67卷

关键词：

Delirium; Palliative care; Antipsychotics; Real-world data; Delirium Rating Scale revised-98; RATING-SCALE; OPEN TRIAL; HALOPERIDOL; RISPERIDONE; REVISED-98; MANAGEMENT; LORAZEPAM; ISSUES;

D O I：

10.1016/j.genhosppsych.2020.09.001

中图分类号：

R749 [精神病学];

学科分类号：

100205 ;

摘要：

Objective: To clarify the safety and effectiveness of antipsychotic medication for delirium in patients with advanced cancer receiving palliative care. Methods: This was a prospective observational study involving consecutive patients with advanced cancer and delirium receiving antipsychotics in inpatient hospices or psycho-oncology settings. Adjusted mean scores of the Delirium Rating Scale Revised-98 (DRS; range: 0-39) were calculated at baseline and Day 3 using generalized estimating equations. Adverse events over 7 days were evaluated. Results: Data from 756 patients were analyzed (Mage = 72 +/- 11 years, 62% male, 48% bedridden). The adjusted mean DRS score significantly decreased after antipsychotics administration (21.5 [95% confidence interval 19.5 to 23.4] to 20.8 [18.9 to 22.8], p = 0.03, effect size [ES] = 0.02). Significant improvement was associated with age of 75 or older (ES = 0.07), better performance status (0.32), longer estimated prognosis (0.25), psycho-oncological consultation settings (0.20), hyperactive (0.14) or mix-motor subtypes (0.24) of delirium, and quetiapine administration (0.19); significant deterioration was observed in patients with "days" prognosis (0.18). Extrapyramidal symptoms (9.8%) and somnolence (8.5%) were the most prevalent adverse events. Conclusions: The use of antipsychotics as part of comprehensive delirium management was safe and may provide some symptomatic benefits for patients with terminal illness and delirium. Along with adequate non -pharmacological interventions, judicious use of antipsychotics is still recommended.

引用

页码：35 / 41

页数：7

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