Treatment of Delirium

1. Treatment of Delirium
Treatment of
Delirium
Treatment of
Delirium

2. autonomic overactivity and manifested as agitation, tremulousness,
and hallucinations.
Considered by some to be a specific type of confusional state that is
characterized by increased vigilance along with psychomotor and
autonomic overactivity and manifested as agitation, tremulousness,
and hallucinations.
Considered by some to be a specific type of confusional state that is
characterized by increased vigilance along with psychomotor and
autonomic overactivity and manifested as agitation, tremulousness,
and hallucinations.
Considered by some to be a specific type of confusional state that is
characterized by increased vigilance along with psychomotor and
autonomic overactivity and manifested as agitation, tremulousness,
and hallucinations.
Considered by some to be a specific type of confusional state that is
characterized by increased vigilance along with psychomotor and
autonomic overactivity and manifested as agitation, tremulousness,
and hallucinations.
Considered by some to be a specific type of confusional state that is
characterized by increased vigilance along with psychomotor and
autonomic overactivity and manifested as agitation, tremulousness,
and hallucinations.
Considered by some to be a specific type of confusional state that is
characterized by increased vigilance along with psychomotor and
autonomic overactivity and manifested as agitation, tremulousness,
and hallucinations.
Considered by some to be a specific type of confusional state that is
characterized by increased vigilance along with psychomotor and
autonomic overactivity and manifested as agitation, tremulousness,
and hallucinations.
Considered by some to be a specific type of confusional state that is
characterized by increased vigilance along with psychomotor and
autonomic overactivity and manifested as agitation, tremulousness,
and hallucinations.
Considered by some to be a specific type of confusional state that is
characterized by increased vigilance along with psychomotor and
autonomic overactivity and manifested as agitation, tremulousness,
and hallucinations.
Considered by some to be a specific type of confusional state that is
characterized by increased vigilance along with psychomotor and

3. Subtypes:
Hyperactive
characterized by agitation, restlessness, and emotional lability
Hypoactive
decreased responsiveness, withdrawal, and apathy
Mixed
Periods of hyperactivity and lethargy.
Incidence :
60%-80% of mechanically ventilated patients
50%-70% of non-ventilated patients
Hypoactive delirium = 43.5%
Hyperactive delirium = 1.6%
Mixed delirium = 54.1%
Mixed delirium = 54.1%
Mixed delirium = 54.1%
Mixed delirium = 54.1%
Subtypes:
Hyperactive
characterized by agitation, restlessness, and emotional lability
Hypoactive
decreased responsiveness, withdrawal, and apathy
Mixed
Periods of hyperactivity and lethargy.
Incidence :
60%-80% of mechanically ventilated patients
50%-70% of non-ventilated patients
Hypoactive delirium = 43.5%
Hyperactive delirium = 1.6%
Mixed delirium = 54.1%
Mixed delirium = 54.1%
Mixed delirium = 54.1%
Mixed delirium = 54.1%

4. Outcome:
-3 fold increase in 6 month mortality
-1 in 3 delirium survivors develop permanent cognitive
impairment
-Associated with:
New nursing home placement
Increased length of stay > 8.0 days
Increased mortality
Increased number of days on the ventilator.
-Associated with:
Depression/PTSD
Increased risk of aspiration
Increased need for re-intubation
Increased hospital cost: national burden $38 billion/year
Increased hospital cost: national burden $38 billion/year
Increased hospital cost: national burden $38 billion/year
Outcome:
-3 fold increase in 6 month mortality
-1 in 3 delirium survivors develop permanent cognitive
impairment
-Associated with:
New nursing home placement
Increased length of stay > 8.0 days
Increased mortality
Increased number of days on the ventilator.
-Associated with:
Depression/PTSD
Increased risk of aspiration
Increased need for re-intubation
Increased hospital cost: national burden $38 billion/year
Increased hospital cost: national burden $38 billion/year
Increased hospital cost: national burden $38 billion/year

5. Prevention:
-Avoiding factors known to cause or aggravate delirium, such as
multiple medications, dehydration, immobilisation, sensory
impairment, and sleep disturbance
-Identifying and treating the underlying acute illness.
-Providing supportive and restorative care to prevent further
physical and cognitive decline
-Where appropriate, controlling dangerous and severely disruptive
behaviours using low dose, short acting pharmacologic agents so
the first three steps can be accomplished.
Prevention:
-Avoiding factors known to cause or aggravate delirium, such as
multiple medications, dehydration, immobilisation, sensory
impairment, and sleep disturbance
-Identifying and treating the underlying acute illness.
-Providing supportive and restorative care to prevent further
physical and cognitive decline
-Where appropriate, controlling dangerous and severely disruptive
behaviours using low dose, short acting pharmacologic agents so
the first three steps can be accomplished.

6. -Orientation protocols : Provision of clocks, calendars,
windows with outside views, and verbally re-orienting patients.
-Cognitive stimulation : Regular visits from family and
friends. At the same time, sensory overstimulation should be
avoided, particularly at night.
-Orientation protocols : Provision of clocks, calendars,
windows with outside views, and verbally re-orienting patients.
-Cognitive stimulation : Regular visits from family and
friends. At the same time, sensory overstimulation should be
avoided, particularly at night.

7. -Facilitation of physiologic sleep :
Nursing and medical procedures should be avoided during sleeping hours when possible. Night time
noise should be reduced.
-Facilitation of physiologic sleep :
Nursing and medical procedures should be avoided during sleeping hours when possible. Night time
noise should be reduced.

8. -Early mobilisation and minimised use of physical
restraints for patients with limited mobility:
-Early mobilisation and minimised use of physical
restraints for patients with limited mobility:

11. -Managing pain:
The use of non-opioid medications should be used where
possible. Clinicians must balance the benefits of using opioids to
treat significant pain with the potential for an opioid-related
delirium.
Meperidine in particular, has been shown in multiple prospective
studies to increase the risk for delirium.
-Managing pain:
The use of non-opioid medications should be used where
possible. Clinicians must balance the benefits of using opioids to
treat significant pain with the potential for an opioid-related
delirium.
Meperidine in particular, has been shown in multiple prospective
studies to increase the risk for delirium.

12. Medications to prevent delirium:
The available evidence does not support the use of medications to prevent delirium in the acute care
or intensive care or postoperative care settings.
Cholinesterase inhibitors● (e.g. rivastigmine; donepezil)has been proposed as a means to
prevent delirium in selected patients and high risk settings (eg, older patients with or without
dementia, postoperative and post-stroke settings) .
However, clinical trials have not demonstrated a reduction in the prevalence or incidence of delirium,
and side effects have been greater in patients receiving these medications.
Medications to prevent delirium:
The available evidence does not support the use of medications to prevent delirium in the acute care
or intensive care or postoperative care settings.
Cholinesterase inhibitors● (e.g. rivastigmine; donepezil)has been proposed as a means to
prevent delirium in selected patients and high risk settings (eg, older patients with or without
dementia, postoperative and post-stroke settings) .
However, clinical trials have not demonstrated a reduction in the prevalence or incidence of delirium,
and side effects have been greater in patients receiving these medications.

13. Antipsychotic agents:Antipsychotic agents:

14. Gabapentin:
Melatonin shows promise in the prevention of delirium.
The melatonin agonist, ramelteon was associated with a lower risk
of delirium.
was associated with a lower risk of delirium.
was associated with a lower risk of delirium.
was associated with a lower risk of delirium.
was associated with a lower risk of delirium.
Gabapentin:
Melatonin shows promise in the prevention of delirium.
The melatonin agonist, ramelteon was associated with a lower risk
of delirium.
was associated with a lower risk of delirium.
was associated with a lower risk of delirium.
was associated with a lower risk of delirium.
was associated with a lower risk of delirium.

15. Management:
-Expert consensus and observational studies.
-Only a small number of controlled clinical trials, which are difficult
to perform in patients with cognitive impairment.
-Treatment of the underlying disease.
-Supportive medical care.
-Managing agitation.
-Managing pain.
-Hypoactive delirium.
-Hypoactive delirium.
-Hypoactive delirium.
-Hypoactive delirium.
-Hypoactive delirium.
-Hypoactive delirium.
-Hypoactive delirium.
-Hypoactive delirium.
-Hypoactive delirium.
-Expert consensus and observational studies.
-Only a small number of controlled clinical trials, which are difficult
to perform in patients with cognitive impairment.
-Treatment of the underlying disease.
-Supportive medical care.
-Managing agitation.
-Managing pain.
-Hypoactive delirium.
-Hypoactive delirium.
-Hypoactive delirium.
-Hypoactive delirium.
-Hypoactive delirium.
-Hypoactive delirium.
-Hypoactive delirium.
-Hypoactive delirium.
-Hypoactive delirium.

16. Treatment of underlying cause:
The conditions noted most commonly in prospective studies of
delirium include:
Metabolic encephalopathy. Wernicke’s encephalopathy.●
•Fluid and electrolyte disturbances.
•Infections (sepsis, urinary tract, respiratory tract, skin and soft-
tissue).
•Organ Failure.
•Hypoglycaemia.
Drug toxicity: 30 percent of all cases of delirium. Clinicians must●
be aware that delirium can occur even with "therapeutic" levels of
such agents as Digoxin or Lithium, particularly in at risk patients.
Withdrawal from alcohol and sedatives.●
●Withdrawal from alcohol and sedatives.
●Withdrawal from alcohol and sedatives.
●Withdrawal from alcohol and sedatives.
●Withdrawal from alcohol and sedatives.
Treatment of underlying cause:
The conditions noted most commonly in prospective studies of
delirium include:
Metabolic encephalopathy. Wernicke’s encephalopathy.●
•Fluid and electrolyte disturbances.
•Infections (sepsis, urinary tract, respiratory tract, skin and soft-
tissue).
•Organ Failure.
•Hypoglycaemia.
Drug toxicity: 30 percent of all cases of delirium. Clinicians must●
be aware that delirium can occur even with "therapeutic" levels of
such agents as Digoxin or Lithium, particularly in at risk patients.
Withdrawal from alcohol and sedatives.●
●Withdrawal from alcohol and sedatives.
●Withdrawal from alcohol and sedatives.
●Withdrawal from alcohol and sedatives.
●Withdrawal from alcohol and sedatives.

17. Supportive medical care:
Adequate hydration, nutrition and mobility .
Control of pain and discomfort
Prevent skin breakdown, ameliorating incontinence.
Minimise the risk of aspiration pneumonitis.
Care to exhausted family and caregivers.
Non-pharmacological interventions:
Mild confusion and agitation may respond to interpersonal and
environmental manipulations.
The hospital environment, characterized by high ambient noise, poor
lighting, lack of windows, frequent room changes, and restraint use, often
contributes to worsening confusion.
Frequent reassurance, touch, and verbal orientation can lessen disruptive
behaviours; family members or other familiar persons are preferred, but
professional sitters can also be used to effect.
Delusions and hallucinations should be neither endorsed nor challenged.
Delusions and hallucinations should be neither endorsed nor challenged.
Delusions and hallucinations should be neither endorsed nor challenged.
Supportive medical care:
Adequate hydration, nutrition and mobility .
Control of pain and discomfort
Prevent skin breakdown, ameliorating incontinence.
Minimise the risk of aspiration pneumonitis.
Care to exhausted family and caregivers.
Non-pharmacological interventions:
Mild confusion and agitation may respond to interpersonal and
environmental manipulations.
The hospital environment, characterized by high ambient noise, poor
lighting, lack of windows, frequent room changes, and restraint use, often
contributes to worsening confusion.
Frequent reassurance, touch, and verbal orientation can lessen disruptive
behaviours; family members or other familiar persons are preferred, but
professional sitters can also be used to effect.
Delusions and hallucinations should be neither endorsed nor challenged.
Delusions and hallucinations should be neither endorsed nor challenged.
Delusions and hallucinations should be neither endorsed nor challenged.

18. Managing Agitation:
Neuroleptic medications :Used to treat severe agitation in
patients with delirium.
Did not reduce the incidence of delirium but the severity and
duration of episodes.
Treatment with either haloperidol or chlorpromazine resulted in
significant improvement in delirium compared to baseline.
Managing Agitation:
Neuroleptic medications :Used to treat severe agitation in
patients with delirium.
Did not reduce the incidence of delirium but the severity and
duration of episodes.
Treatment with either haloperidol or chlorpromazine resulted in
significant improvement in delirium compared to baseline.

19. Haloperidol remains the standard therapy because of the longer clinical experience.
Based on limited evidence, it is recommended that low-dose (0.5 to 1.0 mg)up to a max dose
of 5 mg per day. Intravenous Haloperidol has been associated with clinically significant QT
prolongation.
The newer atypical antipsychotic agents Quetiapine, Resperidone, ziprasidone, and
Olanazepine have fewer side effects, and in small studies they appear to have similar efficacy
to haloperidol.
Ameta-analysis of three small studies that compared Haloperidol with Resperidone and
Olanazpine found that the three agents were similarly effective in treating delirium.
Haloperidol remains the standard therapy because of the longer clinical experience.
Based on limited evidence, it is recommended that low-dose (0.5 to 1.0 mg)up to a max dose
of 5 mg per day. Intravenous Haloperidol has been associated with clinically significant QT
prolongation.
The newer atypical antipsychotic agents Quetiapine, Resperidone, ziprasidone, and
Olanazepine have fewer side effects, and in small studies they appear to have similar efficacy
to haloperidol.
Ameta-analysis of three small studies that compared Haloperidol with Resperidone and
Olanazpine found that the three agents were similarly effective in treating delirium.

20. Haloperidol:
-Atypical butyrophenone type antipsychotic that exhibits high affinity dopamine D2 receptor
antagonism.
-Haloperidol is used in the control of the symptoms of:
• Schizophrenia.
• Acute psychosis, such as drug-induced psychosis caused by LSD, psilocybin,
amphetamines, ketamine, and phencyclidine, and psychosis associated with high fever or
metabolic disease
• Hyperactivity, aggression
• Hyperactive delirium (to control the agitation component of delirium)
• Otherwise uncontrollable, severe behavioural disorders in children and adolescents
• Agitation and confusion associated with cerebral sclerosis.
• Adjunctive treatment of alcohol and opioid withdrawal
• Treatment of severe nausea and emesis in postoperative and palliative care, especially for
palliating adverse effects of radiation therapy and chemotherapy in oncology
• Treatment of neurological disorders, such as tic disorders such as Tourette syndrome,
and chorea
• Therapeutic trial in personality disorders, such as borderline personality disorder
• Treatment of intractable hiccups
• Alcohol-induced psychosis
• Hallucinations in alcohol withdrawal
alcohol withdrawal
alcohol withdrawal
Haloperidol:
-Atypical butyrophenone type antipsychotic that exhibits high affinity dopamine D2 receptor
antagonism.
-Haloperidol is used in the control of the symptoms of:
• Schizophrenia.
• Acute psychosis, such as drug-induced psychosis caused by LSD, psilocybin,
amphetamines, ketamine, and phencyclidine, and psychosis associated with high fever or
metabolic disease
• Hyperactivity, aggression
• Hyperactive delirium (to control the agitation component of delirium)
• Otherwise uncontrollable, severe behavioural disorders in children and adolescents
• Agitation and confusion associated with cerebral sclerosis.
• Adjunctive treatment of alcohol and opioid withdrawal
• Treatment of severe nausea and emesis in postoperative and palliative care, especially for
palliating adverse effects of radiation therapy and chemotherapy in oncology
• Treatment of neurological disorders, such as tic disorders such as Tourette syndrome,
and chorea
• Therapeutic trial in personality disorders, such as borderline personality disorder
• Treatment of intractable hiccups
• Alcohol-induced psychosis
• Hallucinations in alcohol withdrawal
alcohol withdrawal
alcohol withdrawal

21. • Muscle rigidity
• Akathisia (motor restlessness)
• Parkinsonism (characteristic symptoms such as rigidity)
• Hypotension
• Anticholinergic side effects such as:
• Constipation
• Dry mouth
• Blurred vision
• Somnolence
Unknown frequency
• Prolonged QT interval
• Orthostatic hypotension
• Increased respiratory rate
• Anemia
• Visual disturbances
• Headache
Headache
Headache
Headache
Headache
Headache
Headache
Headache
Headache
Headache
Headache
Headache
Headache
Headache
• Akathisia (motor restlessness)
• Parkinsonism (characteristic symptoms such as rigidity)
• Hypotension
• Anticholinergic side effects such as:
• Constipation
• Dry mouth
• Blurred vision
• Somnolence
Unknown frequency
• Prolonged QT interval
• Orthostatic hypotension
• Increased respiratory rate
• Anemia
• Visual disturbances
• Headache
Headache
Headache
Headache
Headache
Headache
Headache
Headache
Headache
Headache
Headache
Headache
Headache
Headache
Headache

22. Benzodiazepines:
Primarily indicated in cases of sedative drug and alcohol
withdrawal or when neuroleptic drugs are contraindicated.
Overprescribed for patients with delirium.
Benzodiazepines:
Primarily indicated in cases of sedative drug and alcohol
withdrawal or when neuroleptic drugs are contraindicated.
Overprescribed for patients with delirium.

23. Managing pain:
In the appropriate setting (postoperative, post-trauma), the role
of pain as a contributor to delirium and agitation should be
considered, and analgesia provided.
Therapies to reduce pain should be administered with some
caution as they also have the potential to contribute to
delirium.
In one randomised study of 53 patients after cardiac surgery,
those who received morphine 5 mg IM) had more rapid
improvement of agitation and were less likely to require
additional sedatives than those who were administered
haloperidol (5 mg IM). Other outcomes were not assessed.
In one randomised study of 53 patients after cardiac surgery,
those who received morphine 5 mg IM) had more rapid
improvement of agitation and were less likely to require
additional sedatives than those who were administered
Managing pain:
In the appropriate setting (postoperative, post-trauma), the role
of pain as a contributor to delirium and agitation should be
considered, and analgesia provided.
Therapies to reduce pain should be administered with some
caution as they also have the potential to contribute to
delirium.
In one randomised study of 53 patients after cardiac surgery,
those who received morphine 5 mg IM) had more rapid
improvement of agitation and were less likely to require
additional sedatives than those who were administered
haloperidol (5 mg IM). Other outcomes were not assessed.
In one randomised study of 53 patients after cardiac surgery,
those who received morphine 5 mg IM) had more rapid
improvement of agitation and were less likely to require
additional sedatives than those who were administered

24. Delirium Management Algorithm:Delirium Management Algorithm:

25. Alpha 2 Agonists:Alpha 2 Agonists:

29. Hypoactive delirium:
Symptomatic treatment is not used for hypoactive delirium.
One study suggested that patients with hypoactive delirium have a
similar response to treatment with haloperidol as those who were
agitated .
Other case reports and one uncontrolled case series have
suggested that treatment with the stimulant drug methylphenidate
may be associated with improved alertness and cognition.
Other case reports and one uncontrolled case series have
suggested that treatment with the stimulant drug methylphenidate
may be associated with improved alertness and cognition.
Other case reports and one uncontrolled case series have
suggested that treatment with the stimulant drug methylphenidate
may be associated with improved alertness and cognition.
Other case reports and one uncontrolled case series have
suggested that treatment with the stimulant drug methylphenidate
Hypoactive delirium:
Symptomatic treatment is not used for hypoactive delirium.
One study suggested that patients with hypoactive delirium have a
similar response to treatment with haloperidol as those who were
agitated .
Other case reports and one uncontrolled case series have
suggested that treatment with the stimulant drug methylphenidate
may be associated with improved alertness and cognition.
Other case reports and one uncontrolled case series have
suggested that treatment with the stimulant drug methylphenidate
may be associated with improved alertness and cognition.
Other case reports and one uncontrolled case series have
suggested that treatment with the stimulant drug methylphenidate
may be associated with improved alertness and cognition.
Other case reports and one uncontrolled case series have
suggested that treatment with the stimulant drug methylphenidate

30. OUTCOMES :
Prolonged hospitalisations, functional and cognitive decline,
higher mortality and higher risk for institutionalisation, even after
adjusting for baseline differences in age, co-morbid illness, or
dementia.
Mortality:
-Mortality associated with delirium is high.
-A report of pooled results from several studies estimated mortality
approximately twice that of patients without delirium.
-Delirium was an independent marker for mortality at 6 or 12
months after hospitalisation.
-Studies have also found a relationship between the duration of
delirium and mortality.
OUTCOMES :
Prolonged hospitalisations, functional and cognitive decline,
higher mortality and higher risk for institutionalisation, even after
adjusting for baseline differences in age, co-morbid illness, or
dementia.
Mortality:
-Mortality associated with delirium is high.
-A report of pooled results from several studies estimated mortality
approximately twice that of patients without delirium.
-Delirium was an independent marker for mortality at 6 or 12
months after hospitalisation.
-Studies have also found a relationship between the duration of
delirium and mortality.

31. -One long-term follow-up study found that after two years, only
one-third of patients who had experienced delirium still lived
independently in the community .
-Another prospective study found that those who experienced
delirium were more likely to have persistent drop in MMSE scores
over baseline at six months compared to those who did not suffer
delirium at 12 months.
-In a study of 821 patients, the duration of delirium was associated
with worse cognitive function at 3 and 12 months.
-While only 6 percent had cognitive impairment at baseline, at 12
months, 34 percent had deficits that were similar to patients with
moderate traumatic brain injury .
at 12 months, 34 percent had deficits that were similar to patients
with moderate traumatic brain injury .
at 12 months, 34 percent had deficits that were similar to patients
with moderate traumatic brain injury .
at 12 months, 34 percent had deficits that were similar to patients
with moderate traumatic brain injury .
at 12 months, 34 percent had deficits that were similar to patients
-One long-term follow-up study found that after two years, only
one-third of patients who had experienced delirium still lived
independently in the community .
-Another prospective study found that those who experienced
delirium were more likely to have persistent drop in MMSE scores
over baseline at six months compared to those who did not suffer
delirium at 12 months.
-In a study of 821 patients, the duration of delirium was associated
with worse cognitive function at 3 and 12 months.
-While only 6 percent had cognitive impairment at baseline, at 12
months, 34 percent had deficits that were similar to patients with
moderate traumatic brain injury .
at 12 months, 34 percent had deficits that were similar to patients
with moderate traumatic brain injury .
at 12 months, 34 percent had deficits that were similar to patients
with moderate traumatic brain injury .
at 12 months, 34 percent had deficits that were similar to patients
with moderate traumatic brain injury .
at 12 months, 34 percent had deficits that were similar to patients

32. SUMMARY AND RECOMMENDATIONS:
●Effective measures to prevent delirium include avoiding where possible, those
factors known to cause or aggravate delirium, orientation protocols, environmental
modification and non-pharmacologic sleep aids, early mobilisation and minimising
use of physical restraints, and visual and hearing aids.
Prophylactic medications (cholinesterase inhibitors, antipsychotic agents) have not●
been conclusively demonstrated to prevent delirium.
●Thiamine supplementation should be considered in all patients with delirium.
When the underlying● acute illness responsible for delirium is identified, specific
therapy is directed toward that condition as the most effective means of reversing
the delirium.
●Physical restraints should be used only as a last resort.
●Frequent reassurance, touch, and verbal orientation from familiar persons can
lessen disruptive behaviours.
can lessen disruptive behaviours.
can lessen disruptive behaviours.
can lessen disruptive behaviours.
SUMMARY AND RECOMMENDATIONS:
●Effective measures to prevent delirium include avoiding where possible, those
factors known to cause or aggravate delirium, orientation protocols, environmental
modification and non-pharmacologic sleep aids, early mobilisation and minimising
use of physical restraints, and visual and hearing aids.
Prophylactic medications (cholinesterase inhibitors, antipsychotic agents) have not●
been conclusively demonstrated to prevent delirium.
●Thiamine supplementation should be considered in all patients with delirium.
When the underlying● acute illness responsible for delirium is identified, specific
therapy is directed toward that condition as the most effective means of reversing
the delirium.
●Physical restraints should be used only as a last resort.
●Frequent reassurance, touch, and verbal orientation from familiar persons can
lessen disruptive behaviours.
can lessen disruptive behaviours.
can lessen disruptive behaviours.
can lessen disruptive behaviours.

33. ●A cautious trial of psychotropic medication should be reserved for
treatment of severe agitation or psychosis with the potential for harm.
In this setting, using low-dose haloperidol (0.5 to 1.0 mg Po or IM)
(Grade 2-C)
•Haloperidol is associated with a low frequency of sedation and
hypotension and should be avoided in Parkinson’s, for whom atypical
antipsychotics are preferred.
●Benzodiazepines should be avoided in patients with or at risk for
delirium, except in cases of sedative drug and alcohol withdrawal or
when neuroleptic medications are contraindicated.
●Delirium may require weeks or months to fully resolve. Episodes of
delirium may adversely affect the course of the disease in patients with
Alzheimer disease.
. Episodes of delirium may adversely affect the course of the disease
in patients with Alzheimer disease.
●A cautious trial of psychotropic medication should be reserved for
treatment of severe agitation or psychosis with the potential for harm.
In this setting, using low-dose haloperidol (0.5 to 1.0 mg Po or IM)
(Grade 2-C)
•Haloperidol is associated with a low frequency of sedation and
hypotension and should be avoided in Parkinson’s, for whom atypical
antipsychotics are preferred.
●Benzodiazepines should be avoided in patients with or at risk for
delirium, except in cases of sedative drug and alcohol withdrawal or
when neuroleptic medications are contraindicated.
●Delirium may require weeks or months to fully resolve. Episodes of
delirium may adversely affect the course of the disease in patients with
Alzheimer disease.
. Episodes of delirium may adversely affect the course of the disease
in patients with Alzheimer disease.
UMMARY AND RECOMMENDATIONS: