Kanser Hastalarında Deliryum-Antipsikotikler ve Diğer Psikotroplar
Özet
Deliryum, kanser hastalarında farkındalık, dikkat ve bilişte ani bozulmalarla gelişen, mortaliteyi en az iki kat artıran akut bir nöropsikiyatrik sendromdur. Hastalığın yönetiminde non-farmakolojik yaklaşımlar (HELP programı gibi) önleyici olsa da, terminal dönem kanser hastalarında bu durum büyük oranda klinik farklılık gösterir. Şiddetli hiperaktif ve dirençli terminal deliryum olgularında antipsikotikler temel tedavi seçeneğidir; ilk sırada haloperidol önerilirken, alternatif olarak olanzapin, risperidon ve ketiapin gibi ajanlar da kullanılmaktadır. Ancak antipsikotik kullanımı, özellikle meme kanserli hastalarda serum prolaktin düzeyini yükseltme riski ve trombositopeni gibi komorbiditeler sebebiyle dikkatle yönetilmelidir. Kanser ünitelerinde ayrıca irritabilite, steroid kaynaklı mizaç değişiklikleri ve nöropatik ağrı için valproik asit, lityum gibi duygudurum dengeleyiciler; akut anksiyete, bulantı, insomni ve palyatif sedasyon süreçleri için ise lorazepam ve midazolam gibi benzodiazepinler sıklıkla tercih edilmektedir. Antiepileptiklerin ve benzodiazepinlerin karaciğer enzim sistemleri ve diğer merkezi sinir sistemi depresanları ile etkileşim riskleri, onkoloji hastalarında yakın takip gerektirmektedir.
Delirium is an acute neuropsychiatric syndrome characterized by sudden impairments in awareness, attention, and cognition in cancer patients, increasing mortality risk by at least twofold. Although non-pharmacological approaches like the HELP program are preventative in management, this condition shows great clinical variance in terminal-stage cancer patients. In cases of severe hyperactive and refractory terminal delirium, antipsychotics are the primary treatment option; while haloperidol is recommended first, agents like olanzapine, risperidone, and quetiapine serve as alternatives. However, the use of antipsychotics must be managed cautiously due to the risk of elevating serum prolactin levels, particularly in breast cancer patients, and comorbidities such as thrombocytopenia. Furthermore, mood stabilizers like valproic acid and lithium are utilized in cancer units for irritability, steroid-induced mood changes, and neuropathic pain, whereas benzodiazepines like lorazepam and midazolam are frequently preferred for acute anxiety, nausea, insomnia, and palliative sedation protocols. The interaction risks of antiepileptics and benzodiazepines with liver enzyme systems and other central nervous system depressants mandate close monitoring in oncology patients.
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