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KMID : 0605720100160020093
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Journal of the Korean Society of Biological Therapies in Psychiatry
2010 Volume.16 No. 2 p.93 ~ p.101
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Practical Guide to Terminal Delirium
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Cheon Jin-Sook
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Abstract
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Objectives: Delirium is the second most frequent psychiatric problems experienced in patients who are in palliative care. However, psychiatrists have not involved and have paid no attention to the care of terminal patients who are impending to death till now. The purpose of this study is to insist the importance of psychiatrists’ devotion to the care of terminal patients, in which professional training should be preceded.
Methods: The English articles and e-news documents published from 1990 through 2010 are reviewed, which are obtained by internet search with words combination of terminal delirium, palliative care, end-of-life care and well-dying.
Results: 1) Frequency : Delirium develops in 20% to 70% of patients who are in palliative care. Almost 90% to 95% of patients experience delirium within 48 hrs of near death. 2) Implications : Terminal delirium causes emotional suffering to the patients. The unusual behavior adds burden toward the family members and caregivers. Ultimately, the communication difficulty and uncooperation to treatment facilitates mortality as well as impairs meaningful exchange of good-bye at time of impending death. 3) Symptoms : The four hallmark symptoms of delirium are impairment of consciousness, other cognitive impairment, acute onset and symptom fluctuation and sleep-wake cycle change. In behavioral view, delirium can be classified into hypoactive, hyperactive and mixed patterns. 4) Etiologies : Delirium pathophysiology may develop by combined action of predisposing(vulnerability) factors and incident factors. 5) Management : The management of terminal delirium consists of keen assessment, identification and reverse of causes, and combination of pharmacological, environmental and spiritual interventions.
Conclusion: Terminal delirium occurred in almost all patients at the end of life is difficult experience toward patients as well as family, beloved and caregivers. Terminal delirium develops by the combined action of multifatorial etiologies. In treatment, multidisciplinary care combined with pharmacological, environmental and spiritual interventions is desirable.
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KEYWORD
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Palliative care, Terminal delirium, Mortality, Multifactorial etiology, Multidisciplinary management
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