Treatment of Delirium
Delirium is an organic psychiatric syndrome characterized by fluctuating consciousness and impairment in cognition, perception, and behavior. It is generally short-lived and has symptoms similar to longer duration psychosis seen in patients suffering from schizophrenia, major depression with psychosis, or bipolar disorder with psychosis.
Delirium may be caused by diseases of body systems other than the brain, by poisons, by fluid/electrolyte or acid/base disturbances, and by other serious, acute conditions. Infections such as urinary tract infections or pneumonia may trigger delirium in individuals with pre-existing brain damage (prior strokes, dementia).
Older adults are at significant risk of delirium if they are admitted to hospital, where 15-50% of over 65 year olds develop delirium. It is most prevalent (25-60%) in elderly patients admitted for hip fracture surgery. Delirium usually develops within the first two days of hospitalization, and rarely presents after the sixth day. It is associated with longer hospital stays and higher mortality rates. For those not already in long term care, older adults who develop delirium whilst hospitalised are more likely to be discharged to a RACF. Due to the trend for early hospital discharge, patients transferred to RACF may still have symptoms of delirium.
Treatment of Delirium
Treatment of delirium begins with recognizing and treating the underlying cause. Delirium itself is managed by reducing disturbing stimuli, or providing soothing ones; use of simple, clear language in communication; and reassurance, especially from family members. Physical restraints may be needed if the patient is a danger to himself or others, or if he insists on removing necessary medical equipment such as intravenous lines or monitors. Sedatives or anti psychotic drugs may be used to reduce anxiety, hallucinations, and delusions.
The delirious patient should never be left unattended. Physical restraint should be minimized to that required to gain initial control of an uncooperative patient and to undertake procedures and prevent self-harm prior to pharmacological sedation. When required, physical restraint is best accomplished by holding the patient with the assistance of several people.
The goal of treatment is to control or reverse the cause of the symptoms. Treatment depends on the condition causing delirium. Diagnosis and care should take place in a pleasant, comfortable, non-threatening, physically safe environment. The person may need to stay in the hospital for a short time. Stopping or changing medications that worsen confusion, or that are not necessary, may improve mental function.
Drug Therapy: Identification and correction of the etiologic condition may be sufficient to reverse delirium. However, some cases of delirium, especially in the elderly, are protracted and may take weeks to clear. Subclinical delirium lasting months has been associated with hepatic encephalopathy. Specific pharmacologic intervention may become necessary to help to reduce the intensity and duration of delirium. The medication of choice is a low-dose, high-potency neuroleptic.
Hospitalization: Being in the hospital, particularly intensive care units (ICUs), can contribute to or trigger delirium. In ICUs, people are isolated in a room that typically has no windows or clocks. Thus, people are deprived of sensory stimulation and can become disoriented. Sleep is disturbed by staff members who awaken people during the night to monitor and treat them and by loud beeping monitors, intercoms, voices in the hallway, or alarms.
