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Intervention Review

Drug therapy for delirium in terminally ill adult patients

  1. Kenneth C Jackson1,*,
  2. Arthur G Lipman2

Editorial Group: Cochrane Pain, Palliative and Supportive Care Group

Published Online: 19 APR 2004

Assessed as up-to-date: 17 FEB 2004

DOI: 10.1002/14651858.CD004770


How to Cite

Jackson KC, Lipman AG. Drug therapy for delirium in terminally ill adult patients. Cochrane Database of Systematic Reviews 2004, Issue 2. Art. No.: CD004770. DOI: 10.1002/14651858.CD004770.

Author Information

  1. 1

    Pacific University, School of Pharmacy, Hillsboro, OR, USA

  2. 2

    University of Utah Health Sciences Center, Department of Pharmacotherapy and Pain Management Center, Salt Lake City, Utah, USA

*Kenneth C Jackson, School of Pharmacy, Pacific University, 222 SE 8the Avenue, Suite 451, Hillsboro, OR, 97123, USA. kenneth.jackson@pacificu.edu.

Publication History

  1. Publication Status: Edited (no change to conclusions)
  2. Published Online: 19 APR 2004

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This is not the most recent version of the article. View current version (14 NOV 2012)

 

Abstract

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Background

Delirium is a common disorder that often complicates treatment in patients with life-limiting disease. Delirium is described using a variety of terms such as agitation, acute confusional states, encephalopathy, organic mental disorders, and terminal restlessness. Delirium may arise from any number of causes, and treatment should be directed at addressing these causes. In cases where this is not possible, or does not prove successful, the use of drug therapy may become necessary.

Objectives

The primary objective of this review was to identify and evaluate studies examining medications used to treat patients suffering from delirium during the terminal phases of disease.

Search methods

We searched the following sources: MEDLINE (1966 to July 2003) , EMBASE 1980 to July 2003), CINAHL (1982 to July 2003), PSYCH LIT (1974 to July 2003), PSYCHINFO (1990 to July 2003) and The Cochrane Library Issue 2, 2003) for literature pertaining to this topic.

Selection criteria

Prospective trials with or without randomization and/or blinding involving the use of pharmacological agents for the treatment of delirium at the end of life were considered.

Data collection and analysis

Two review authors independently assessed trial quality using standardized methods and extracted data for evaluation. Outcomes related to both efficacy and adverse effects were collected.

Main results

Thirteen potential studies were identified by the search strategy. Of these, only one study met the criteria for inclusion in this review. This study evaluated 30 hospitalized AIDS patients receiving one of three different agents: chlorpromazine, haloperidol, and lorazepam. Analysis of this trial found chlorpromazine and haloperidol to be equally effective. Chlorpromazine was noted to slightly worsen cognitive function over time but this result was not significant. The lorazepam arm of the study was stopped early as a consequence of excessive sedation.

Authors' conclusions

The data from one study of 30 participants would perhaps suggest that haloperidol is the most suitable drug therapy for the treatment of patients with delirium near the end of life. Chlorpromazine may be an acceptable alternative if a small risk of slight cognitive impairment is not a concern. However, there is insufficient evidence to draw any conclusions about the role of pharmacotherapy in terminally ill patients with delirium, and further research is essential.

 

Plain language summary

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Drug therapy for delirium in terminally ill adult patients

There is limited evidence from clinical trials on the role of drug therapy for the treatment of delirium in terminally ill patients. Delirium occurs frequently in patients with terminal illness, and may be caused by the illness itself or as a side effect of drug treatments for symptom management at the end of life. A search of the international literature for randomized controlled trials of drug therapies for the treatment of delirium in patients with terminal illness yielded only one small study, and it was therefore not possible to assess the effectiveness of treatment options. It is hoped that this review will provide an incentive for further research.

 

摘要

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

背景

用於末期疾病病人的譫妄(delirium)之藥物治療

譫妄是一種常見的疾病,往往使生命有限期的病人治療更加複雜。譫妄被廣泛的名詞所描述,例如激動(agitation),急性混亂狀態(acute confusional states),腦病變(encephalopathy),器質性精神疾病(organic mental disorders)及末期病人的躁動不安(terminal restlessness)。譫妄可能由許多原因所產生,所以治療應針對解決這些潛在問題。在一些不可能治療,或者無法證明治療是成功的病例,使用藥物治療可能會成為必要。

目標

這篇文章的主要目的是找到及評估針對末期病人之譫妄的藥物治療成效的臨床研究。

搜尋策略

我們搜尋了切合這個課題的相關文獻,其來源如下:MEDLINE(從1966年至2003年7月), EMBASE(從 1980年至2003年7月),CINAHL(從1982年至2003年7月),PSYCH LIT(從1974年至2003年7月),PSYCHINFO(從1990年至2003年7月)和,2003年的Cochrane Library Volume 2。

選擇標準

考慮納入有或沒有隨機分組(randomization)及/或使用盲性測驗(blinding)的前瞻性臨床試驗(Prospective trials),這些試驗都與使用藥物製劑治療臨終前的瞻妄有關。

資料收集與分析

二位評論作者,採用標準化方法以及提取的數據,獨立性的評估試驗的品質並收集有關療效和不良反應的結果。

主要結論

有13個可能的研究被搜索策略所選出。其中只有一個研究符合這篇評論的列入標準。這個研究評估30位住院的愛滋病(AIDS)患者,接受三種不同的藥劑,包括chlorpromazine,haloperidol及lorazepam。這個試驗的分析發現chlorpromazine與haloperidol有同樣效果。Chlorpromazine被指出,使用時間過久,對認知功能有些許的惡化,但這結果並無顯著意義。lorazepam的研究,因過度鎮靜效果而被提早終止。

作者結論

從一個納入30位病患的研究資料顯示,或許haloperidol是用於治療臨終病人的譫妄最適合的藥物。如果不擔心引起輕微認知功能障礙的小風險, Chlorpromazine 可能是一個可以接受的替代藥物。但是是有關藥物治療末期病人譫妄的角色為何沒有足夠的證據可以作出任何結論,進一步研究是必要的。

翻譯人

本摘要由三軍總醫院黃子權翻譯。

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。

總結

目前只有有限的證據源自臨床試驗來評估藥物在治療末期病人譫妄之角色。譫妄經常出現在末期病人上,它可能是在臨終前,疾病本身所引起的或是用來處理症狀藥物的副作用。搜尋各種國際性的文獻,只找到一個研究為隨機對照臨床試驗針對末期病人譫妄的藥物治療。因此,本文不可能評估其他選擇治療的成效。我們希望這篇評論能激勵進一步研究的動機。