lasconde_28_06

51 / 156

863
A pesar de lo descrito, se propone como primera línea el uso
de haloperidol en prácticamente todas las guías clínicas,
seguido por otros antipsicóticos de segunda generación que
han acumulado evidencia favorable en los últimos años. La
dificultad que se plantea, es que la calidad de los estudios y
sus resultados no permiten obtener conclusiones absolutas,
y en el caso particular de los pacientes en cuidados palia-
tivos el uso de antipsicóticos podría tener efectos desfavo-
rables.
Está pendiente el desarrollo de mayor investigación que permita
tener modelos predictivos, estandarizar herramientas de diag-
nóstico para pacientes oncológicos, así como su prevención y
tratamiento.
1. Caraceni A, Grassi L. Delirium: acute confusional states in
palliative medicine. 2nd ed. Oxford: Oxford University Press; 2011.
2. Hosie A, Davidson PM, Agar M, Sanderson CR, Phillips J. Delirium
prevalence, incidence, and implications for screening in specialist
palliative care inpatient settings: a systematic review. Palliat
Med. 2013;27:486–98.
3. Grassi L, Caraceni A, Mitchel A, Nanni M, Berardi M, Caruso R, et
al. Management of Delirium in Palliative Care: a Review. Curr
Psychiatry Rep 2015 17:13
4. DeCrane, S. K., Culp, K. R. & Wakefield, B. Twelve-month fall
outcomes among delirium subtypes. J. Healthc. Qual. 2012
Nov-Dec;34(6):13-20
5. Scarpi E, Maltoni M, Miceli R, Mariani L, Caraceni A, Amadori D, et
al. Survival prediction for terminally ill cancer patients: revision
of the palliative prognostic score with incorporation of delirium.
Oncologist 2011;16(12):1793-9
6. Caraceni A, Nanni O, Maltoni M, Piva L, Indelli M, Arnoldi E, et
al. Impact of delirium on the short term prognosis of advanced
cancer patients. Italian Multicenter Study Group on Palliative
Care. Cancer. 2000 Sep 1;89(5):1145-9.
7. Breitbart W, Strout D. Delirium in the terminally ill. Clin Geriatr
Med. 2000;16(2):357-372.
8. Moyer DD. Review article: terminal delirium in geriatric
patients with cancer at end of life. Am J Hosp Palliat Care. 2011
Feb;28(1):44-51.
9. Agar, M. & Lawlor, P. Delirium in cancer patients: a focus on
treatment-induced psychopathology. Curr Opin Oncol. 2008
Jul;20(4):360-6.
10. Rainsford S, Rosenberg JP, Bullen T. Delirium in advanced cancer:
screening for the incidence on admission to an inpatient hospice
unit. J Palliat Med. 2014 Sep;17(9):1045-8.
11. Centeno C, Sanz A, Bruera E. Delirium in advanced cancer patients.
Palliat Med. 2004;18(3):184-194
12. Ahmed S, Laurent B, Sampson EL. Risk factors for incident delirium
among older people in acute hospital medical units: a systematic
review and meta-analysis. Age Ageing. 2014 May;43(3):326-33
13. World Health Organization. Cancer Fact Sheet No297 [online],
html (2014)
14. Rojas O. Estudio exploratorio acerca de los métodos empleados
por los oncólogos en la evaluación de la capacidad para la toma
de decisiones en salud de los pacientes oncológicos de la región
metropolitana. Tesis de Grado Magíster en Bioética, Universidad
de Chile, 2016,
15. Irwin SA, Ferris FD. The opportunity for psychiatry in palliative
care. Can J Psychiatry. 2008;53(11):713–24.
16. Fairman N, Irwin SA. Palliative care psychiatry: update on an
emerging dimension of psychiatric practice. Curr Psychiatry Rep.
2013 Jul;15(7):374.
17. Inouye SK, Westendorp RG, Saczynski JS. Delirium in elderly
people. Lancet 2014 Mar 8;383(9920):911-22.
18. Inouye SK, van Dyck CH, Alessi CA, Balkin S, Siegel AP, Horwitz RI.
Clarifying confusion: the confusion assessment method. A new
method for detection of delirium. Ann Intern Med. 1990 Dec
15;113(12):941-48.
19. World Health Organisation. ICD-10 Classifications of Mental
and Behavioural Disorder: Clinical Descriptions and Diagnostic
Guidelines. 1992.
20. American Psychiatric Association. Diagnostic and statistical
manual of mental disorders: DSM-5. 5th ed Arlington, VA:
American Psychiatric Association; 2013.
21. Leonard M, Nekolaichuk C, Meagher D, et al. Practical assessment
of delirium in palliative care. J Pain Symptom Manage. 2014
Aug;48(2):176-90.
22. Laurila JV, Pitkala KH, Strandberg TE, Tilvis RS. Impact of different
diagnostic criteria on prognosis of delirium: a prospective study.
Dement Geriatr Cogn Disord 2004; 18:240–244.
23. Lipowski ZJ. Transient cognitive disorders (delirium, acute
confusional states) in the elderly. Am J Psychiatry. 1983
Nov;140(11):1426-36.
24. Leonard MM, Agar M, Spiller JA, Davis B, Mohamad MM, Meagher
DJ, et al. Delirium diagnostic and classification challenges
in palliative care: subsyndromal delirium, comorbid delirium
dementia and psychomotor subtypes. J Pain Symptom Manage.
2014 Aug;48(2):199-214
25. Cole MG, Ciampi A, Belzile E, Dubuc-Sarrasin M. Subsyndromal
delirium in older people: a systematic review of frequency, risk
factors, course and outcomes. Int J Geriatr Psychiatry. 2013
Aug;28(8):771-80.
26. Franco JG, Trzepacz PT, Meagher DJ, Kean J, Lee Y, Kim JL, et al.
Three core domains of delirium validated using exploratory
and confirmatory factor analyses. Psychosomatics. 2013
May-Jun;54(3):227-38
27. Trzepacz PT, Mittal D, Torres R, Kanary K, Norton J, Jimerson N.
Validation of the Delirium Rating Scale-revised-98: comparison
with the delirium rating scale and the cognitive test for delirium.
J Neuropsychiatry Clin Neurosci. 2001 Spring;13(2):229-42.
Los autores declaran no tener conflictos de interés, en relación a este artículo.
REFERENCIAS BIBLIOGRÁFICAS
[DELIRIUM EN EL PACIENTE ONCOLÓGICO- Dr. Cristián Fuentes y cols.]