• Isseki Maeda, Asao Ogawa, Kazuhiro Yoshiuchi, Tatsuo Akechi, Tatsuya Morita, Shunsuke Oyamada, Takuhiro Yamaguchi, Kengo Imai, Akihiro Sakashita, Yoshihisa Matsumoto, Keiichi Uemura, Rika Nakahara, Satoru Iwase, and Phase-R Delirium Study Group.
• Department of Palliative Care, Senri-Chuo Hospital, 1-4-3 Shin-senri Higashi-machi, Toyonaka, Osaka, Japan. Electronic address: isseki.maeda@gmail.com.
• Gen Hosp Psychiatry. 2020 Nov 1; 67: 35-41.

ObjectiveTo clarify the safety and effectiveness of antipsychotic medication for delirium in patients with advanced cancer receiving palliative care.MethodsThis was a prospective observational study involving consecutive patients with advanced cancer and delirium receiving antipsychotics in inpatient hospices or psycho-oncology settings. Adjusted mean scores of the Delirium Rating Scale Revised-98 (DRS; range: 0-39) were calculated at baseline and Day 3 using generalized estimating equations. Adverse events over 7 days were evaluated.ResultsData from 756 patients were analyzed (Mage = 72 ± 11 years, 62% male, 48% bedridden). The adjusted mean DRS score significantly decreased after antipsychotics administration (21.5 [95% confidence interval 19.5 to 23.4] to 20.8 [18.9 to 22.8], p = 0.03, effect size [ES] = 0.02). Significant improvement was associated with age of 75 or older (ES = 0.07), better performance status (0.32), longer estimated prognosis (0.25), psycho-oncological consultation settings (0.20), hyperactive (0.14) or mix-motor subtypes (0.24) of delirium, and quetiapine administration (0.19); significant deterioration was observed in patients with "days" prognosis (0.18). Extrapyramidal symptoms (9.8%) and somnolence (8.5%) were the most prevalent adverse events.ConclusionsThe use of antipsychotics as part of comprehensive delirium management was safe and may provide some symptomatic benefits for patients with terminal illness and delirium. Along with adequate non-pharmacological interventions, judicious use of antipsychotics is still recommended.Copyright © 2020. Published by Elsevier Inc.

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