Indeed, it may be the exception for patients to remain mentally clear until death, and delirium has been considered the hallmark of dying. Delirium is a commonly encountered syndrome in palliative medicine, yet it is often unrecognised, misdiagnosed and ignored in clinical practice. Delirium is responsive to palliative interventions even if its aetiology is multidetermined and irreversible. It may be avoidable, or at least the disturbing symptoms and behaviours of terminal delirium may be dampened, by combinations of psychological and medicinal interventions. In managing most delirious patients, continuity of carers and the presence of a near relative is the optimal interpersonal therapeutic strategy.
Haloperidol is the drug of choice for delirium.
Delirium during the terminal phase of life is a sad and distressing condition. The dissolution of autonomy and dignity associated with organic psychosis, the associated stigma of mental illness and the evaporation of quality of remaining life should encourage quick, active and aggressive multidisciplinary palliative interventions. The modern hospice and palliative care movement was developed as a community response to those who were dying, mainly of cancer. The expectations of hospice providers, the models of care and even the policies and procedures reflect this history. In contrast to cancer patients where the transition between curative and palliative care is relatively easily marked, making it easier to decide when to offer hospice care to the patient and family, AIDS patients often experience health 'highs' and 'lows'.