Delirium Management in Patients with Cancer: Dosing of Antipsychotics in the Delirium Subtypes and Response to Psychopharmacological Management

Background: While delirium resolution and persistent delirium in hypoactive and hyperactive delirium have been studied to a certain extent, doses of antipsychotics administered remain unknown. Methods: Patients treated for cancer were recruited at the Memorial Sloan Kettering Cancer Center (MSKCC). Sociodemographic, medical variables, the Memorial Delirium Assessment Scale (MDAS) subitems (1–10) as well as the Karnofsky scale of Performance Status (KPS) were recorded at baseline (T1), 2–3 days (T2) and 4–7 days (T3) and analyzed in respect to the subtypes of delirium and medication doses administered. Results: Between haloperidol, risperidone, olanzapine and aripiprazole, differences existed in respect to the prevalence of dementia, stage of illness, baseline MDAS scores, delirium resolution, and functional status. When hyperactive delirium was present, doses reached fourfold those administered in hypoactive delirium. In particular, haloperidol and olanzapine were administered at higher doses in order to achieve symptom control. When aripiprazole was administered, dosing was similar between the subtypes. Generally, the response to management with antipsychotics was similar between the delirium subtypes, although a trend towards a greater response in hypoactive delirium was noted. However, factors known to cause persistent delirium influenced delirium resolution. Conclusion: The interaction of factors contributing to resolved and persistent delirium in the hypoactive and hyperactive subtype remains complex. In general, the response was comparable between the subtypes. However, patients with hyperactive delirium required higher doses of antipsychotics in order to achieve symptom control (German J Psychiatry 2014; 17(1): 10-18).