Antipsychotics in a cancer setting are often used with different goals than in a general psychiatric setting. In a cancer population, antipsychotics primarily help manage delirium, confusion, agitation, and manic episodes, but they also treat anxiety, insomnia, and nausea and can improve appetite. The potential causes of delirium are many and variable, and must be identified and addressed. However, antipsychotic medication may be needed to facilitate a medical workup to allow appropriate treatment by helping to manage symptoms such as agitation, hallucinations, delusions, and disorganized thinking. This chapter discusses pearls for recognizing delirium because confusion may start insidiously or quickly, lethargically or turbulently, sometimes from an obvious trigger, and sometimes not, and at times in an outpatient setting. Non-prescribers who understand the features of delirium and appreciate the appropriate use of antipsychotics can help educate and support patients and their families to expedite and promote timely and appropriate treatment for a potentially dangerous entity. Non-prescribing clinicians will learn the indications for use of antipsychotics in cancer care, the reasons prescribers chooses different medications in different situations, and to recognize side effects such as akathisia or restlessness, muscle rigidity, and sedation so they can communicate their observations with prescribers.
