Treatment of delirium in supportive and palliative care

The past few years have witnessed increased research into delirium treatment and related issues, leading to better management (e.g. improved detection) and better understanding of phenomenology and pathophysiology. Many treatment and prevention trials have been conducted.

Delirium phenomenology studies revealed that even subsyndromal presentations may bear a poor prognosis. Varied pathophysiology may lead to different delirium subtypes with implications for treatment, especially the hypoactive subtype, for which systematic neuroleptic treatment remains controversial. The high prevalence of delirium has led to improved use of validated instruments and better trials. Nonpharmacological interventions remain an essential step in delirium management and have yielded positive results, especially in prevention. Two trials of haloperidol prophylaxis identified reduced severity and duration of delirium in one and reduced incidence in the other. Trials comparing haloperidol with atypical antipsychotics, mainly risperidone and olanzapine, found equal efficacy but more side effects with haloperidol.

Use of validated detection instruments is now standard procedure in both specialized clinical practice and research. Although haloperidol remains the mainstay of treatment, recent trials have begun to discriminate between the use of different agents and pharmacological approaches.