Department of Psychosomatic Internal Medicine, National Hospital Organization Kinki-Chuo Chest Medical Center, Sakai, Japan.
Department of Palliative and Supportive Care, Seirei Mikatahara General Hospital, Hamamatsu, Japan.
Jpn J Clin Oncol. 2022 Aug 5;52(8):905-910. doi: 10.1093/jjco/hyac081.
The objective of this survey was to identify areas where doctors have divergent practices in pharmacological treatment for hyperactive delirium in terminally ill patients with cancer.
We conducted a survey of Japanese palliative care physicians and liaison psychiatrists. Inquiries were made regarding: (i) choice of drug class in the first-line treatment, (ii) administration methods of the first-line antipsychotic treatment, (iii) starting dose of antipsychotics in the first line treatment and maximum dose of antipsychotics in refractory delirium, and (iv) choice of treatment when the first-line haloperidol treatment failed. Respondents used a five-point Likert scale.
Regarding choice of drug class in the first-line treatment, more doctors reported that they 'frequently' or 'very frequently' use antipsychotics only than antipsychotics and benzodiazepine (oral: 73.4 vs. 12.2%; injection: 61.3 vs. 11.6%, respectively). Regarding administration methods of the first-line antipsychotic treatment, the percentage of doctors who reported that they used antipsychotics as needed and around the clock were 55.4 and 68.8% (oral), 49.2 and 45.4% (injection), respectively. There were different opinions on the maximum dose of antipsychotics in refractory delirium. Regarding the choice of treatment when the first-line haloperidol treatment failed, the percentage of doctors who reported that they increased the dose of haloperidol, used haloperidol and benzodiazepines, and switched to chlorpromazine were 47.0, 32.1 and 16.4%, respectively.
Doctors have divergent practices in administration methods of the first-line antipsychotic treatment, maximum dose of antipsychotics, and choice of treatment when the first-line haloperidol treatment failed. Further studies are needed to determine the optimal treatment.
本调查旨在确定医生在治疗癌症终末期躁动性谵妄的药物治疗方面存在分歧的领域。
我们对日本姑息治疗医师和联络精神科医师进行了调查。询问了以下问题：（i）一线治疗中药物类别的选择，（ii）一线抗精神病治疗的给药方法，（iii）一线抗精神病药物治疗的起始剂量和难治性谵妄的最大剂量，以及（iv）一线氟哌啶醇治疗失败时的治疗选择。回答者使用了五点 Likert 量表。
关于一线治疗中药物类别的选择，更多的医生报告说他们“经常”或“非常频繁”使用抗精神病药物而不是抗精神病药物和苯二氮䓬（口服：73.4%比 12.2%；注射：61.3%比 11.6%）。关于一线抗精神病治疗的给药方法，报告按需和 24 小时给药的医生比例分别为 55.4%和 68.8%（口服）、49.2%和 45.4%（注射）。对于难治性谵妄的抗精神病药物最大剂量存在不同意见。关于一线氟哌啶醇治疗失败时的治疗选择，报告增加氟哌啶醇剂量、使用氟哌啶醇和苯二氮䓬以及改用氯丙嗪的医生比例分别为 47.0%、32.1%和 16.4%。
医生在一线抗精神病药物治疗的给药方法、抗精神病药物的最大剂量以及一线氟哌啶醇治疗失败时的治疗选择方面存在分歧。需要进一步研究以确定最佳治疗方法。
