Effect of Antipsychotics and Non-Pharmacotherapy for the Management of Delirium in People Receiving Palliative Care

Abstract

Evidence to support the use of antipsychotic medications for the management of delirium symptoms remains limited. The primary objective of this study was to compare the effect of antipsychotic and non-antipsychotic treatments for delirium symptoms among palliative care inpatients. Secondary outcomes were use of midazolam and overall survival. This involved retrospective analysis of medical records (November 2018 to April 2019) for adult palliative care patients diagnosed with delirium at an Australian tertiary hospital. NuDESC was used to assess symptoms daily from baseline to Day 3. All 65 patients (mean age 73.5 ± 13.7 years, 48% female, 59% with cancer) included received standard care which included management of underlying causes of delirium symptoms, of which 17 received additional treatment using antipsychotic medications. Forty-eight did not receive any antipsychotic medication. An absolute reduction in NuDESC score was observed in the group that did not receive additional treatment using antipsychotics (by 1.37 units, 95% CI 0.79–1.95, p < 0.0001). A significantly higher proportion of midazolam use (n = 9, 53% versus n = 2, 4%, p < 0.001) and shorter median survival (13 days versus 26 days, p = 0.03) was observed in the group of patients that received antipsychotics. The use of antipsychotic medications in addition to standard treatments targeting underlying precipitants did not lead to a significant improvement in delirium symptoms and was associated with a greater midazolam use and lower median duration of survival. Individualized treatment of underlying causes still appears to be essential in the management of delirium in patients receiving palliative care.

Keywords:

• Delirium
• palliative care
• anti-psychotics

Acknowledgements

All individuals who have devoted significant work to this manuscript have been included as authors. Author contribution: Study concept and design: J.O.; Data collection: K.Y., C.C., F.M.; Data analysis and interpretation: K.Y., E.C.K.T., C.C., F.M., and J.O.; Critical revision for important intellectual content and supervision of study: J.O., E.C.K.T., C.C., and J.H.

Disclosure statement

The authors declared no conflicts of interest with respect to the research, authorship and/or publication of this article.

Additional information

Funding

This research received no specific grant from any funding agency in the public, commercial or not-for-profit sectors. E.C.K.T. was supported by an Australian National Health and Medical Research Council-Australian Research Council (NHMRC-ARC) Dementia Research Development Fellowship (APP1107381).