Delirium diagnosis, screening and management.
Lawlor, Peter G.; Bush, Shirley H.
Current Opinion in Supportive & Palliative Care
Purpose of review: Our review focuses on recent
developments across many settings regarding the diagnosis, screening and
management of delirium, so as to inform these aspects in the context of
palliative and supportive care.
Recent findings: Delirium diagnostic criteria have been
updated in the long-awaited Diagnostic Statistical Manual of Mental
Disorders, fifth edition.
Studies suggest that poor recognition of
delirium relates to its clinical characteristics, inadequate
interprofessional communication and lack of systematic screening.
Validation studies are published for cognitive and observational tools
to screen for delirium. Formal guidelines for delirium screening and
management have been rigorously developed for intensive care, and may
serve as a model for other settings.
Given that palliative sedation is
often required for the management of refractory delirium at the end of
life, a version of the Richmond Agitation-Sedation Scale, modified for
palliative care, has undergone preliminary validation.
Summary:
Although formal systematic delirium screening
with brief but sensitive tools is strongly advocated for patients in
palliative and supportive care, it requires critical evaluation in terms
of clinical outcomes, including patient comfort.
Randomized controlled
trials are needed to inform the development of guidelines for the
management of delirium in this setting.
(C) 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins
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