Confusion

We have all experienced confusion at one time or another. 

Usually it is momentary such waking up after a cat nap. In some patients with cancer confusion can be a distressing problem for the patients themselves and their carers. Wherever possible, the underlying cause of the patient's confusion should be investigated and treated as appropriate. This information sheet summarizes the causes of confusion and possible ways to alleviate it.

Causes of confusion:

• Kidney failure
• Liver failure
• Drug or alcohol withdrawal
• Salts & chemicals*
• Shortness of breath
• Drugs
• Infection
• Brain metastases
• Constipation
• Urinary retention
• Pain
• Anxiety or depression

Salts & chemicals - eg. Dehydration / High calcium - See Bone hardening drugs / High or low sodium / High or low glucose

Drugs - eg Morphine & other opiods / codeine / cimetidine / steroids / benzodiazepines / digoxin

Infection - eg chest, bladder or more seriously meningitis

Management of Confusion and Delirium

·Treat underlying cause where possible
·Explanation to patient and relatives can considerably relieve distress; the presence of a family member at the bedside may have significant calming effect

Drug treatment

Agitation:
diazepam 2-10 mg, max. tds
lorazepam 1-2 mg sublingually/pomidazolam 5 - 10 mg stat subcutaneously10 - 40 mg/12 hourly by sc.infusion

Insomnia: temazepam 10 - 20 mg nocte chlormethiazole 2- 4 tabs nocte

Paranoia:  haloperidol

Hallucinations; chlorpromazine 10 - 25 mg tds polim methotrimeprazine 25 - 200 mg 12 hourly by Sc. infusion/po

Alcohol withdrawal: chlormethiazole 10 -25 mg im

Rapid sedation: methotrimeprazine 12.5 -25 mg stst sc./pc midazolam 5 - 20 mg im chlorpromazine 10 - 25 mg im
Nebuilsed dose: 250 - 500 mgs qds

• Anxiety

a) Psychological support
b) Relaxation techniques
c) Drug treatrnent:-

Benzodiazepines Diazepam 2 - 10 mg stat or tds

Midazolam 5 - 10 mg stat or continous infus (up to 100mg/ 24hrs)

Lorazepam 1 - 2 mg sublingually

Neuroteptics Thioridazine 10 -25 mg stat or tds (especially for agitation)

Haloperidol 1.5 mg - 5 mg stat or up to tds

Imipramine 25 - 50 mg bd

• Depression

a) Psychological support
b) Drug treatment

Tricyclic antidepressants (especially where sleep disorders)
Amitriptyline 25 - 150 mg nocte
Dothiepin 25 - 150 mg nocte
2nd generation antidepressants: better side effect prolile but expensive
Lotepramine 70 -140 mg nocte
Fluoxetine 2O - 60 mg mane

Find a psychological counsellor

Further general information Your doctors and specialist nurses are in an ideal position to give you relevant information on your disease and treatment as they know your individual circumstances. Cancerbackup has a help line (0808 800 1234) and a prize winning video available in English, Italian, Urdu, Bengali, Gujarati & Hindi explaining Radiotherapy & Chemotherapy. Cancernet.co.uk has over 500 pages describing cancer, its management, practical tips and tool which patients, their carers and their doctors have found helpful during the cancer journey.