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Delerium in Pain Patients May Masquerade as Depression

Delerium in Pain Patients May Masquerade as Depression

NEW YORK--About 30% of the cancer patients he is asked to evaluate
for depression turn out to have delirium, said Memorial Sloan-Kettering
psychiatrist William S. Breitbart, MD, at a conference sponsored
by Cancer Care, Inc.

"That's because some patients with delirium are hypoalert,
lethargic as opposed to agitated. They're lying in bed curled
up in the fetal position, looking sad, but the patients' mental
status has not been evaluated," he said. "No one has
asked the patient--Do you know where you are? Do you know the
name of this place? Do you know what room you're in?"

Such patients may have trouble talking and naming things, or may
have frank aphasia. They may hallucinate. "The disturbance
often develops over a short period of time, and the symptoms may
fluctuate," Dr. Breitbart pointed out.

The delirium usually exists in the context of some physical cause,
and is common in cancer patients who are in pain and receiving
opiates. He pointed out that most patients on stable doses of
oral opioids have completely intact mental function.

"They're oriented, alert, and able to think clearly. But
uncontrolled pain can interfere dramatically with the ability
to concentrate," he said. "Patients are more likely
to get confused and disoriented during periods of rapid dose escalation,
whether orally or intravenously."

Intravenous or subcutaneous infusions are often used to get rapid
control over exacerbation of pain in the hospital, and sometimes
in the home setting. "So it's really during these periods
of rapid escalation of dose that oncologists see delirium,"
he said.

Treating the Delirium


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