Should Neuroleptics Be Used in Patients With Delirium Seen by Palliative Care?
Should Neuroleptics Be Used in Patients With Delirium Seen by Palliative Care?
复制标题
接受姑息治疗的谵妄患者是否应该使用抗精神病药？
DOI：
10.1016/j.jpainsymman.2022.09.015
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发表时间：
2023
期刊：
影响因子：
--
通讯作者：
Maeda I.
中科院分区：
文献类型：
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作者：
Hui D;Agar M;Maeda I.
谵妄通常发生在姑息治疗环境中，并影响患者护理的许多方面，如症状评估、医患沟通和医疗决策。关于在姑息治疗环境中谵妄管理的一个有争议的话题是是否应该使用抗精神病药。在这篇“姑息治疗的争议”文章中，三位专家临床医生独立回答了这个问题。具体来说，每个小组都提供了一个关键研究的摘要，以告知他们的思维过程，分享他们临床方法的实用建议，并强调未来研究的机会。有趣的是，所有三位专家都得出了相似的结论——他们强调了识别和治疗任何可逆转的谵妄原因的重要性，并支持进行非药物措施的试验。他们还一致认为，对于保守措施不能控制谵妄症状的多动性谵妄或混合性谵妄患者，以及预期寿命仅剩几天，因而没有时间尝试其他措施的谵妄患者，应考虑使用抗精神病药。诸如锥体外系症状和癫痫发作等不良反应的风险应作为治疗决定的一部分加以考虑。还需要进行高质量的研究，以检查精神抑制药和神经抑制药保留策略对谵妄的管理。
Delirium commonly occurs in the palliative care setting and impacts many aspects of patient care, such as symptom assessment, patient-clinician communication, and medical decision-making. One controversial topic regarding the management of delirium in the palliative care setting is whether neuroleptics should be used. In this “Controversies in Palliative Care” article, 3 expert clinicians independently answer this question. Specifically, each group provides a synopsis of the key studies that inform their thought processes, share practical advice on their clinical approach, and highlight the opportunities for future research. Interestingly, all 3 experts arrived at similar conclusions—they underscored the importance of identification and treatment of any reversible causes of delirium and endorsed a trial of non-pharmacologic measures. They also agreed that neuroleptics should be considered for patients with hyperactive or mixed delirium when the conservative measures fail to control delirium symptoms and for delirious patients with days of life expectancy and thus limited time to try other measures. Risk of adverse effects such as extrapyramidal symptoms and seizures should be considered as part of the treatment decision. There is also a need to conduct high quality research to examine both neuroleptics and neuroleptic-sparing strategies for the management of delirium.