Materiały źródłowe

• #1 Sudden confusion (delirium)

  https://www.nhs.uk/conditions/confusion/

  Sudden confusion (delirium) can have many different causes. Get medical help immediately if someone suddenly becomes confused (delirious). […] Many causes of sudden confusion need to be assessed and treated as soon as possible. Sometimes it may be life threatening. […] Sudden confusion can be caused by many different things. Do not try to self-diagnose. Get medical help if someone suddenly becomes confused or delirious.

• #2 Emergency Treatment for Delirium or Sudden Confusion | Goshen Health

  https://goshenhealth.com/services-conditions/delirium-confusion

  Sudden confusion, or delirium, is a rapid change in your mental state. Its when you cant think clearly and have a lack of awareness about your environment. Delirium can last several hours or days. […] If you or someone with you has delirium, its important to seek immediate medical attention. […] At Goshen Hospital Emergency Department, our team works together to provide prompt care for sudden onset symptoms like confusion. We use the latest technologies and techniques to ensure that we deliver leading-edge treatment. […] Once we know the cause of delirium, we provide an effective treatment. We understand that when it comes to treating sudden confusion, minutes count. Whether its caused by a stroke or fever, we put our patients first.

• #3 Delirium: What It Is, Symptoms, Treatment & Types

  https://my.clevelandclinic.org/health/diseases/15252-delirium

  How is delirium treated, and is there a cure? […] Theres no specific treatment or medication for delirium. Instead, healthcare providers will treat causes and contributing factors they can identify. Helping people with mobility and activity or removing tethers can help delirium get better. Monitoring and adjusting medications can also help improve delirium while you undergo treatment for the underlying causes. […] There arent any medications that treat delirium directly. Instead, medications treat underlying causes or specific delirium symptoms. That means the treatments can vary widely depending on the contributing factors and your symptoms. Healthcare providers may consider antipsychotic medications for treating hyperactive delirium because they reduce agitation and combativeness. […] Delirium is often preventable, but most preventive measures are things only clinical personnel should do. However, family, friends and loved ones can play a very important role in reducing the risk of delirium.

• #4 Caring for Someone With Delirium | Memorial Sloan Kettering Cancer Center

  https://www.mskcc.org/cancer-care/patient-education/delirium

  The best way to treat delirium is to find and treat the thing that’s causing it. […] Once the cause of the delirium is found, treatment can start. There are no medications that treat delirium itself. […] Instead, the person’s healthcare provider may give them medication to treat what is causing the delirium. Or, they may give them medication to treat certain delirium symptoms. For example, if the person is upset or nervous, they may get medication to help them relax. […] In addition to medication, other things can help treat someone with delirium. The person’s care team may take certain medical equipment out of their hospital room if it’s not needed. This can help the person feel safer. They may also have someone stay in the room with the person, such as a nursing assistant. They can help make sure the person stays safe.

• #5 Patient education: Delirium (Beyond the Basics) – UpToDate

  https://www.uptodate.com/contents/delirium-beyond-the-basics/print

  Delirium is a sudden and severe change in brain function that causes a person to appear confused or disoriented, or to have difficulties maintaining focus, thinking clearly, and remembering recent events, typically with a fluctuating course. […] The goal of treatment is to address the cause of delirium when possible and to keep the person safe as they recover from their illness. […] There is no specific treatment for delirium. Instead, treatment focuses on several basic principles: […] Identify and treat the underlying illness […] Provide supportive and restorative care […] Control dangerous and disruptive behaviors to avoid harm to the patient or others. […] In people with a first episode of delirium, the initial treatment is often provided in a hospital setting. This allows the health care provider to monitor the patient, begin treatment of the underlying problem, and develop a long-term care plan with the patient and/or family.

• #6 Delirium and acute confusional states: Prevention, treatment, and prognosis – UpToDate

  https://www.uptodate.com/contents/delirium-and-acute-confusional-states-prevention-treatment-and-prognosis

  Delirium and acute confusional states: Prevention, treatment, and prognosis […] The management of delirium is based primarily upon expert consensus and observational studies, and only a small number of controlled clinical trials, which are difficult to perform in patients with cognitive impairment. […] Prevention and therapy of delirium are based on the following principles: […] Avoiding factors known to cause or aggravate delirium, such as multiple medications, dehydration, immobilization, sensory impairment, and disruption of the sleep-wake cycle […] Identifying and treating the underlying acute illness.

• #7 Delirium (sudden confusion) – Overview | Guy’s and St Thomas’ NHS Foundation Trust

  https://www.guysandstthomas.nhs.uk/health-information/delirium-sudden-confusion

  Depending on how bad the delirium is, a person may need to go into hospital for treatment and management. For others, delirium can be treated at home. […] Some people with delirium need to come into hospital to manage the condition or what is causing it. They might also be in hospital for another reason and get delirium during their stay. […] The doctors and nurses test for and manage any causes of delirium that can be treated. Examples are: infections, abnormal blood results, constipation (finding it hard to poo), not being able to pee, dehydration, the side effects of different medicines. […] Sometimes, we give the person with delirium calming or sedating medicines. We use these medicines if the person is still distressed or unsafe after we have tried other ways to keep them calm. […] Delirium usually gets better. In 6 out of 10 people (60%), the symptoms disappear within 6 days. Others may have some symptoms for longer. About 1 in 20 people (5%) may still have delirium more than a month after they first had symptoms.

• #8 Acute Confusional States in the Elderly—Diagnosis and Treatment

  https://pmc.ncbi.nlm.nih.gov/articles/PMC3371633/

  Delirium is common, has multiple causes and causes distress to numerous patients and their relatives. […] A careful history and examination with appropriate investigation allows underlying causes to be detected and treated. Rehabilitation strategies should be initiated without delay. Neuroleptics and benzodiazepines have an established role in the pharmacological treatment even of the hyperactive subtype. Non-pharmacological treatments include the creation of a calm and patient centred environment, and the involvement of relatives. […] The treatment of delirium can be directed at the causes of delirium, its manifestations, or both; symptomatic treatment can be either with drugs or with non-pharmacological means. […] The cause of delirium in the individual patient should be treated, if possible. For example, fluid and electrolyte imbalances should be corrected, infections cured with antibiotics, anticholinergic drugs discontinued, nonconvulsive status epilepticus broken with antiepileptic drugs, and withdrawal syndromes treated. […] Patients with other (hyperactive) types of delirium are usually treated with antipsychotic drugs, despite the sparsity of scientific evidence for this practice. […] Non-pharmacological measures also play a major role in the treatment of delirium.

• #9 Delirium – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK470399/

  The main treatments for delirium are based on non-pharmacologic interventions, as there are no FDA-approved medications for the treatment or prevention of delirium. Preventing delirium from occurring is the most efficacious intervention. Identifying patients at risk for delirium and taking special precautions to prevent delirium is crucial. Non-modifiable risk factors include a history of an underlying neurodegenerative disorder such as dementia and increasing age. Modifiable factors include medications, infections, environmental factors, and reduced sensory input. The American Geriatrics Society has supported the Hospital Elder Life Program (HELP), which has been shown to reduce the incidence of delirium in elderly patients. This is an interdisciplinary program with many components. Interventions include decreasing environmental disturbances and prioritizing uninterrupted sleep. During the day, guidelines encourage the use of eyeglasses or hearing aids to optimize hearing and vision, the use of tools to improve orientation, including clocks and calendars to remind individuals where they are, early morning rise times, and adequate fluid intake. It supports frequent mobilization and reduction in tethers, such as urinary catheters or IV lines that limit mobility. Therapeutic activities such as music therapy are encouraged when appropriate. It is known these strategies are cost-effective and remain the primary treatment for delirium. The HELP program has also been shown to reduce the rate of falls by 42% and reduce hospital costs per patient by $1600 to $3800 (2018 U.S. dollars) and over $16,000 (2018 U.S. dollars) per person-year of long-term care costs in the year following a delirium episode.

• #10 Delirium – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/delirium/diagnosis-treatment/drc-20371391

  The first goal of delirium treatment is to address any causes or triggers. That may include stopping certain medicines, treating an infection or treating an imbalance in the body. Treatment then focuses on creating the best setting for healing the body and calming the brain. […] Supportive care aims to prevent complications. Here are steps to take: Protect the airway, Provide fluids and nutrition, Assist with movement, Treat pain, Address a lack of bladder control, Avoid the use of physical restraints and bladder tubes, Avoid changes in surroundings and caregivers when possible, Include family members or familiar people in care. […] If you’re a family member or caregiver of someone who has delirium, talk with the health care provider about medicines that may trigger the symptoms. The provider may suggest that the person avoid taking those medicines or that a lower dose is given. Certain medicines may be needed to control pain that’s causing delirium.

• #11 Delirium – Neurologic Disorders – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/neurologic-disorders/delirium-and-dementia/delirium

  Treatment of underlying disorder and removal of exacerbating factors. […] Supportive care. […] Management of agitation. […] Correcting the cause (eg, treating infection, giving fluids and electrolytes for dehydration) and removing exacerbating factors (eg, stopping medications) may result in resolution of delirium. Nutritional deficiencies (eg, of thiamin or vitamin B12) should be corrected, and good nutrition and hydration should be provided. […] Additional management considerations may vary depending on the patient population and clinical scenario (eg, ICU care, post-operative care in older adults). […] The environment should be stable, quiet, and well-lit and include visual cues to orient the patient (eg, calendar, clocks, family photographs). Frequent reorientation and reassurance by hospital staff or family members may also help.

• #12 Delirium – Brain, Spinal Cord, and Nerve Disorders – Merck Manual Consumer Version

  https://www.merckmanuals.com/home/brain-spinal-cord-and-nerve-disorders/delirium-and-dementia/delirium

  Promptly correcting or treating the condition causing delirium usually cures it. […] If the cause of delirium is identified and corrected quickly, delirium can usually be cured. […] Once the cause is identified, it is promptly corrected or treated. For example, doctors treat infections with antibiotics, dehydration with fluids and electrolytes given intravenously, and delirium due to stopping alcohol with benzodiazepines. […] Prompt treatment of the disorder causing delirium usually prevents permanent brain damage and may result in a complete recovery. […] General measures are also important. […] The environment is kept as quiet and calm as possible. […] People who have delirium are prone to many problems, including dehydration, undernutrition, incontinence, falls, and pressure sores. […] Management of agitation includes measures to prevent injuries. […] Medications are used to manage agitation only after all other measures have been ineffective. […] Most people with delirium recover fully if the condition causing delirium is rapidly identified and treated.

• #13 Delirium – symptoms, diagnosis and treatment | Alzheimer’s Society

  https://www.alzheimers.org.uk/get-support/daily-living/delirium

  Delirium is treated by resolving the health problems that have caused it. Once this is done, its important to make conditions as ideal as possible for the persons brain to recover. […] Some causes of delirium can be treated very quickly. Others may take several days or more to get better for example, if they have a serious infection. However, the symptoms of delirium will usually improve once its causes are found and treated. […] A supportive and calm environment can also help someone recover from delirium. Healthcare professionals, family and friends can all help a person by: talking calmly in short clear sentences, reminding them where they are and who you are, bringing familiar objects from home, such as photographs, helping them to eat and drink regularly, making sure glasses and hearing aids are clean and working properly, and that they are wearing them, setting up a 24-hour clock and calendar that they can see clearly, helping them get into a healthy sleep routine, providing reassurance if they have distressing hallucinations or delusions, supporting them to get up and about, as soon as its safe to do so, not taking them to new environments that are unfamiliar, busy or confusing.

• #14 Delirium and Sleep Disturbance

  https://mydoctor.kaiserpermanente.org/mas/structured-content/Condition_Delirium_sleep_-_Critical_Care.xml?co=/regions/mas

  The treatment of delirium starts with addressing the underlying factors that triggered the confused mental state. For example, this may mean treating an infection, minimizing or stopping particular medications, or adequately treating pain. […] The next step is to create the best possible environment to help the brain recover. The involvement of family members and caregivers is extremely important. The following approaches may be used: Use clocks and calendars to help with orientation. Family members and caregivers regularly tell the person what day and time it is, where they are, and what’s happening around them. Talking about current events and playing word games can also help. Create a comfortable environment by placing familiar objects from home in the hospital room. Get out of bed and walk at least a few times a day. Certain exercises may also be recommended. Reestablish a regular sleep pattern by keeping the blinds open during the day to encourage daytime alertness and turning the lights off at night. We minimize the noise at night to allow for uninterrupted sleep. We also make efforts not to wake you or your family member in the early morning hours unless absolutely necessary. Wear eyeglasses, hearing aids, and dentures if needed. […] If the above methods are ineffective or if a person experiences severe agitation or paranoia, medications may be used to manage delirium.

• #15 Hypoactive Delirium: Differential Diagnosis, Evaluation, and Treatment

  https://www.psychiatrist.com/pcc/hypoactive-delirium-differential-diagnosis-evaluation-treatment/

  Multicomponent nonpharmacologic strategies that focus on enhancing cognition (eg, frequent reorientation, cognitive stimulation, music therapy, use of clocks, access to natural daylight), minimizing oversedation and sleep disruption (eg, reducing use of sedating agents, minimizing exposure to bright lights and loud noises, allowing periods of undisrupted sleep), increasing mobility (eg, encouraging early rehabilitation/mobilization), and reducing hearing and visual impairment (eg, wearing hearing aids and glasses) have consistently been shown to reduce the development and duration of delirium, as well as in-hospital mortality. […] Recently updated guidelines (eg, on the management of pain, agitation/sedation, delirium, immobility, and sleep disruption) do not recommend the routine use of pharmacologic treatments for motoric subtypes of delirium.

• #16 How to Help a Loved One with Post-operative Delirium

  https://www.asahq.org/brainhealthinitiative/publications-news-videos/articlesandnews/helpalovedone

  Delirium after surgery is often temporary, but it can affect your loved ones recovery, leading to a longer hospital stay or discharge to a rehabilitation facility instead of directly to home. […] If your loved one develops delirium after surgery in the hospital or at home after surgery, there are steps you can take as a family member or a close friend to help him/her recover faster. […] Dr. Ohs recommendations are based on principles of the Hospital Elder Life Program (HELP), a comprehensive patient-care program staffed by volunteers that helps prevent delirium and loss of functioning for older adults that doesnt involve medication. […] Many aspects of the HELP program can also be helpful for managing delirium, Dr. Oh says. […] If you notice symptoms of delirium such as confusion or agitation in your loved one after coming home from the hospital, dont wait until the home health nurse is scheduled to arrive in a few days or for your loved ones official follow-up surgical appointment, Dr. Oh says.

• #17 Delirium in Older Persons: Evaluation and Management | AAFP

  https://www.aafp.org/pubs/afp/issues/2014/0801/p150.html

  Delirium is defined as an acute, fluctuating syndrome of altered attention, awareness, and cognition. […] Treatment of delirium should focus on identifying and managing the causative medical conditions, providing supportive care, preventing complications, and reinforcing preventive interventions. […] Pharmacologic interventions should be reserved for patients who are a threat to their own safety or the safety of others and those patients nearing death. […] Antipsychotic medications should be used as a last resort in treating delirium and should not be used indiscriminately in persons with delirium who have not been properly evaluated. […] Once delirium is diagnosed in an inpatient setting, it is important to identify and treat the underlying causes. After the causative factors are addressed, focus should shift to nonpharmacologic measures, providing supportive care, and preventing complications.

• #18 Delirium Medication: Antipsychotics, Benzodiazepines, Vitamins, Hypnotic, Miscellaneous

  https://emedicine.medscape.com/article/288890-medication

  Delirium that causes injury to the patient or others should be treated with medications. The most common medications used are antipsychotic medications. While this is a common and seemingly useful strategy, the literature is still mixed. A 2015 meta-analysis of 15 studies found that second-generation antipsychotics (SGAs) may treat delirium better than placebo, usual care, or haloperidol. A 2016 meta-analysis of 19 studies found that antipsychotic use was not associated with change in delirium duration, severity, or hospital or ICU length of stay. […] Benzodiazepines often are used for alcohol and benzodiazepine withdrawal states. […] Recent clinical trials showed that the melatonin supplement and its receptor agonist ramelteon may be useful in the prevention and management of delirium. Melatonin levels were found to be altered in delirium subjects. Melatonin is available over the counter in North America. Ramelteon has been approved by the FDA for the treatment of insomnia.

• #19 What is delirium? Symptoms, causes, diagnosis, and treatment

  https://www.medicalnewstoday.com/articles/326684

  The Food and Drug Administration (FDA) have not approved any medications for the treatment of delirium itself. The first-line treatment for delirium usually focuses on identifying and treating the underlying cause. […] Doctors can prescribe medications to treat the underlying cause of delirium. For example, if someone has an untreated bacterial infection, a doctor is likely to prescribe a course of antibiotics. […] Doctors may prescribe low dosages of psychotropic medications to people who have severe or dangerous symptoms, such as extreme agitation or demonstrating violent behaviors. Examples of psychotropic medications that a doctor might prescribe include: antidepressants, sedatives, dopamine blockers. […] According to the authors of a 2018 review article, people may continue experiencing symptoms of delirium for several days to months after doctors start treating the underlying cause.

• #20 Delirium

  https://www.rcpsych.ac.uk/mental-health/mental-illnesses-and-mental-health-problems/delirium

  If someone becomes confused they need to see a doctor urgently. […] Once a physical cause has been identified, it needs to be treated. For example, a chest infection will be treated with antibiotics. […] Even when someone is confused, there are simple steps that can be taken to help them feel safer and less agitated. These include: explaining to the person what has happened, and why they feel confused; reassuring them that they are safe; helping them to know what time it is and where they are – a large clock and a written message about where they are can be helpful; having familiar items from home around the bedside; having friends and family visit; making sure that someone has their glasses and hearing aids and that they are working! […] Some people become so distressed that medication may be needed to calm them down. Unfortunately, sedative medications may do this but also make the delirium worse. So, sedatives should only be prescribed if a confused person: becomes a danger to themselves or other people; is very agitated or anxious; believes others are trying to harm them; is seeing or hearing things that are not there low doses of anti-psychotic medication can help; needs calming down so that they can have important investigations or treatment; is someone who usually drinks a lot of alcohol and has stopped suddenly to stop them having fits, they will need a regular dose of a sedative medication (a benzodiazepine), reduced over several days under close medical and nursing supervision. […] Any sedative medication should be given at the lowest possible dose, for the shortest possible time.

• #21 Delirium | health.vic.gov.au

  https://www.health.vic.gov.au/older-people-in-hospital/cognition-dementia-delirium-and-depression/delirium

  Delirium should be treated as a medical emergency. […] Delirium can often be prevented and can be treated and managed. […] There are many things we can do to help older people and their families and carers understand, prevent and manage delirium. […] Reducing, ceasing or avoiding the use of psychoactive drugs is recommended as they may worsen the delirium. […] Pharmacological therapy should only be considered in severe cases of behavioural or emotional disturbance because there is no strong evidence they effectively improve prognosis. […] Always document the indications for using and stopping use of antipsychotic medication in the patients medical history. […] Review the use and effectiveness of any medications regularly by monitoring the patient for over-sedation, postural hypotension and Parkinsonism.

• #22 Delirium – Definition, Symptoms, and Causes

  https://www.mentalhealth.com/library/delirium

  It is rare that delirium will be treated with direct medication in the first instance. However, certain symptoms such as psychosis may pose a threat to the individual or others and further treatment will require pharmacological intervention first. Medications used to treat aggressive delirium symptoms include: Haloperidol (Haldol®), Risperidone (Risperdal®), Olanzapine (Zyprexa®).

• #23 Delirium: Emergency Evaluation and Treatment

  https://www.psychiatrictimes.com/view/delirium-emergency-evaluation-and-treatment

  Delirium can exert a psychological toll on the patient as well as the delirious patient’s spouse and caregiver. […] The treatment of a patient with delirium in the ED has 2 important and related aspects: identification and treatment of the underlying medical condition and the active management of the symptoms of delirium. […] Initial management should be directed at the diagnosis and reversal of the fundamental causes of the delirium. […] While evaluation and management of potential precipitating and perpetuating causes are under way, simultaneous management of the behavioral symptoms of delirium is imperative. […] The primary goal of symptomatic management is ensuring the safety of the patient and those around him or her. […] Antipsychotic medications, which exhibit dopamine antagonism, are the cornerstone of symptomatic delirium treatment and often help ameliorate the symptoms of delirium even before the underlying cause of delirium is identified and corrected.

• #24 Delirium Medication: Antipsychotics, Benzodiazepines, Vitamins, Hypnotic, Miscellaneous

  https://emedicine.medscape.com/article/288890-medication

  This class of drugs are the medication of choice in the treatment of psychotic symptoms of delirium. Older antipsychotics such as haloperidol, a high-potency antipsychotic, are useful but have adverse neurological effects. Newer neuroleptics such as risperidone, olanzapine, and quetiapine relieve symptoms while minimizing adverse effects. […] Reserved for delirium resulting from seizures or withdrawal from alcohol or sedative hypnotics. Coadministration with antipsychotics is considered only in patients who tolerate lower doses of either medication or have prominent anxiety or agitation. […] Patients with alcoholism and patients with malnutrition are prone to thiamine and vitamin B-12 deficiency, which can cause delirium. […] Agents in this class may be useful in the prevention and management of delirium.

• #25 Confusion (delirium in the elderly)

  https://emed.ie/Symptoms/Confusion.php

  Delirium is avoidable and treatable not an accepted factor in ageing!! […] Immediate while identifying and correcting underlying causes: […] Low dose haloperidol – 0.25mg and 0.5mg every 4 hrs in elderly. Higher doses re- prolongation of QT interval. IV haloperidol is twice as potent as in oral form.

• #26 Delirium | Canadian Cancer Society

  https://cancer.ca/en/treatments/side-effects/delirium

  Managing delirium involves discussing treatments with the healthcare team and considering how these treatments align with care decisions. Treatment doesn’t always improve delirium in people with advanced cancer. In some cases, especially if the person with cancer is nearing the end of life, you may decide not to treat delirium. […] The type of treatment offered for delirium will depend on the test results. Treatments may include changing medicines or doses of medicines, or stopping medicines; giving fluids with needles placed in the skin (subcutaneous) to treat dehydration; antibiotics to treat an infection; pain control; giving oxygen; and removing a catheter from the bladder. […] If the person with delirium is becoming distressed or upset or if it seems they might harm themselves or someone else, the healthcare team may use medicine to help ease these symptoms. There are no standard medicines for cancer-related delirium but the following drugs may be offered: olanzapine (Zyprexa), quetiapine (Seroquel), and aripiprazole (Abilify).

• #27 Management of acute confusion (delirium) in older people – South & West

  https://southwest.devonformularyguidance.nhs.uk/formulary/chapters/4-central-nervous-system/acute-confusion-in-older-people

  Heart disease […] Any features of Parkinson’s disease or extra-pyramidal side-effects (EPSE) […] Dementia with Lewy Bodies (DLB) (see below) […] Neuroleptic malignant syndrome. […] Dementia with Lewy Bodies (DLB): patients are extremely sensitive to antipsychotic medication and this may result in a sudden onset of EPSE, profound confusion, deterioration and death. DLB accounts for approx. 15% of cases of dementia among people aged over 65 (overall population incidence 0.75%). Characteristic symptoms are dementia, marked fluctuation of cognitive ability, early and persistent visual hallucinations and spontaneous motor features of Parkinsonism. […] Specialist referral recommended. […] Consider the presence of depression and treat accordingly.

• #28 Delirium: Emergency Evaluation and Treatment

  https://www.psychiatrictimes.com/view/delirium-emergency-evaluation-and-treatment

  Both hypoactive and hyperactive subtypes of delirium have been effectively managed with antipsychotics. […] Currently, no medications have been approved by the FDA for the management of delirium. […] Management of alcohol-withdrawal and sedative-hypnotic-withdrawal delirium states requires the use of benzodiazepines. […] Delirium associated with seizure activity is also appropriately managed with benzodiazepines. […] In addition, benzodiazepines may augment the effects of high-potency typical antipsychotics in patients with severe refractory delirium, thereby reducing the total dose of antipsychotic required and improving tolerability.

• #29 SOP: treatment of delirium | Neurological Research and Practice | Full Text

  https://neurolrespract.biomedcentral.com/articles/10.1186/s42466-021-00110-7

  Antipsychotic treatment should be limited to the management of symptoms imposing a safety risk for the patient or medical staff or which are highly stressful for the patient. […] Benzodiazepines have only proven to be beneficial in combination with haloperidol but not in monotherapy. […] In the ICU-setting, the alpha2-agonist dexmedetomidine has the most promising results in the treatment of delirium by shortening its duration and by shortening the duration of mechanical ventilation as well as the length of stay in the ICU. […] There is no conclusive data supporting the use of medication for the prevention of delirium. […] In order to prevent delirium, risk factors should be identified and taken into account when planning the hospital stay and treatment. Prevention and treatment of delirium should be based on the elimination of potential causes and on non-pharmacological interventions. Pharmacological treatment should be used in a time-limited manner and in the lowest possible dose for the management of highly stressful symptoms or high-risk behaviour if non-pharmacological treatment is not effective.

• #30 Hypoactive Delirium: Differential Diagnosis, Evaluation, and Treatment

  https://www.psychiatrist.com/pcc/hypoactive-delirium-differential-diagnosis-evaluation-treatment/

  Antipsychotic agents have been studied widely for their efficacy in the management of delirium. […] These studies seem to suggest that antipsychotics may not reduce the frequency, severity, or duration of delirium in critically ill patients. […] Several randomized, placebo-controlled trials have demonstrated that antipsychotics are efficacious in the management of heterogeneous motor types of delirium. […] Psychostimulants could alleviate disturbances of arousal and attention that are associated with hypoactive delirium; however, clinicians are often concerned that such an intervention might increase agitation. […] Antipsychotic agents and psychostimulants have a bevy of side effects that warrant careful consideration before they are used in patients with hypoactive delirium. […] The role of temperature management in critically ill patients is complex. […] Electroconvulsive therapy (ECT) can be helpful in benzodiazepine-resistant or life-threatening cases, with impressive response rates.

• #31 Postoperative delirium in seniors: Recognizing the symptoms, reducing the risks | Aging | Brain | UT Southwestern Medical Center

  https://utswmed.org/medblog/postoperative-delirium-seniors-recognizing-symptoms-reducing-risks/

  Post-operative delirium is the most common complication of surgery for older adults, according to the American Geriatric Society, affecting up to 50% of seniors. […] If not identified early and treated, post-operative delirium can lead to long-term health issues, including cognitive decline and functional decline. […] While we work to resolve the underlying issue, we also work with the patient’s family to provide general comfort and support such as encouraging proper eating, exercising, and sleeping. […] There is no medication to treat postoperative delirium, and prevention is key. […] The first step to treat a patient with delirium is to identify the cause of their symptoms. […] UT Southwestern has recently implemented the Hospital Elder Life Program (HELP) program on our ACE unit to care for older patients with or at risk for delirium.

• #32 Ask the Expert: Prevention and Treatment of Post-Operative Delirium | HealthInAging.org

  https://www.healthinaging.org/tools-and-tips/ask-expert-prevention-and-treatment-post-operative-delirium

  The American Geriatrics Society Clinical Guideline for Post-Operative Delirium recommends the following to treat postoperative delirium: Healthcare professionals should consider working with an interdisciplinary team to use multiple approaches to treatment. These can include approaches such as improving sleep, helping to reorient the older person to their surroundings, or engaging in therapeutic activities. […] The healthcare professional should not prescribe antipsychotic or benzodiazepine medications for older delirious patients who are not agitated or threatening substantial harm to themselves or others. In all cases, antipsychotic medicines should only be used if behavioral interventions have failed or are not possible. Ongoing use should be evaluated daily by the healthcare professional.

• #33 Confusion and Delirium | Cancer-related Side Effects | American Cancer Society

  https://www.cancer.org/cancer/managing-cancer/side-effects/changes-in-mood-or-thinking/confusion.html

  Treatment for delirium and confusion depends on the cause. Many times, treating the cause will ease or get rid of delirium or confusion. The cancer care team will do an assessment to look at any physical causes or medicines that might be causing the confusion or delirium. They may also want to do some tests, such as blood work, to try and find the cause. […] Not all causes of delirium and confusion can be treated. This is often true when a person is nearing the end of their life. In that case, making the person comfortable may be the best option. […] There are medicines that can make a person with confusion or delirium more comfortable. The cancer care team may suggest sedation if a person is very agitated and not getting better with other treatments. Sedation can make the person who is dying more comfortable. […] Deciding how to treat confusion or delirium depends on what the person with cancer would like. If possible, people should talk with their cancer care team about their treatment options ahead of time and think about putting their health care wishes in writing.

• #34 Delirium in palliative care | Information for professionals | Marie Curie

  https://www.mariecurie.org.uk/professionals/palliative-care-knowledge-zone/delirium

  Delirium usually improves if healthcare professionals can find and treat the underlying causes. For example, giving antibiotics for an infection, encouraging the person to drink more fluids if they’re dehydrated, or reviewing their medication. Delirium may have more than one cause. […] Medicines such as antipsychotics and benzodiazepines can be used to treat delirium-related distress. But these should only be used if the person is very distressed and other strategies have not helped. This is because these medicines can worsen delirium and cause other adverse effects. If medicines are needed, healthcare professionals should review these regularly, and withdraw them as soon as the person recovers. […] Towards the end of life, healthcare professionals should focus on ensuring the person is comfortable and manage their symptoms. Agitation can be a symptom of delirium. But agitation may be caused by other problems, such as pain, breathlessness, constipation or being in urinary retention. It’s important to find out what’s causing the distress and address it, if possible. Delirium causing agitation in the last hours or days of life is sometimes called terminal agitation. The person may groan or shout in a confused way. They may be restless, fidgety, pull at their bedcovers, or try to get out of bed when it’s unsafe for them to do so. Medicines, such as antipsychotics and benzodiazepines, may be needed to ensure the person remains calm and comfortable.

• #35 Delirium (sudden confusion) – Overview | Guy’s and St Thomas’ NHS Foundation Trust

  https://www.guysandstthomas.nhs.uk/health-information/delirium-sudden-confusion

  When a person leaves hospital after delirium, they may need more support than usual. They may be at higher risk of falls and need some changes in the home to make sure that their environment is safe. […] We try to make sure that people get the right level of support when they leave hospital. This includes rehabilitation to improve, restore and maintain their everyday skills and mobility.

• #36 Postoperative delirium in seniors: Recognizing the symptoms, reducing the risks | Aging | Brain | UT Southwestern Medical Center

  https://utswmed.org/medblog/postoperative-delirium-seniors-recognizing-symptoms-reducing-risks/

  If more advanced care is needed, the doctor will talk with you about the potential for healthcare help at home or rehabilitation. […] It’s important for patients and family members to discuss their health history and personal risk factors with their doctor before surgery to potentially avoid delirium. […] In that spirit, we’ve implemented two programs focused on post-operative delirium: one to help identify patients who are at risk and another to help patients and families manage the condition if it develops.

• #37 How to Help a Loved One with Post-operative Delirium

  https://www.asahq.org/brainhealthinitiative/publications-news-videos/articlesandnews/helpalovedone

  Medication miscommunication is a reason many older patients land back in the hospital or may contribute to changes in mental status, Dr. Oh says. […] Your loved ones delirium could simply be related to misunderstanding about what medication(s) he/she should or should not be taking. […] Instead, keep your loved one mentally engaged throughout the day by with conversation and activities he/she likes to do. […] Movement helps speed recovery in general. […] Keeping a regular sleep/wake schedule, such as going to bed by 10 p.m., is important for everyones brain function, but especially those with delirium after surgery. […] All of these things are critical for helping someone recover from delirium faster.

• #38 Delirium Treatment & Management: Approach Considerations, Medical Care, Consultations

  https://emedicine.medscape.com/article/288890-treatment

  Following recovery, patient’s memories of events of the delirium are variable. Be sure to educate the patient, family, and primary caregivers about future risk factors. […] When delirium is diagnosed or suspected, the underlying causes should be sought and treated. Despite every effort, no cause for delirium can be found in a small percentage of patients. Components of delirium management include supportive therapy and pharmacological management. […] Fluid and nutrition should be given carefully because the patient may be unwilling or physically unable to maintain a balanced intake. For the patient suspected of having alcohol toxicity or alcohol withdrawal, therapy should include multivitamins, especially thiamine. […] Reorientation techniques or memory cues such as a calendar, clocks, and family photos may be helpful. The environment should be stable, quiet, and well-lighted.

• #39 Hospital Delirium: Symptoms, Treatment, and Recovery

  https://www.healthline.com/health/hospital-delirium

  Some medications that doctors commonly prescribe in the ICU are linked to a higher risk of delirium. If someone may be at high risk for delirium, doctors may consider avoiding these medications. Examples include: benzodiazepines, anticholinergics, opioids, antipsychotics, propofol (Diprivan). […] Preventing hospital delirium can be a challenge for caregivers. Certain aspects of the hospital environment and the care provided are beyond your control. […] There are still ways in which you can help your loved one: Initiate conversations with them, orient them after a medical procedure such as surgery, help them get up and walk around when possible, make sure they have their personal items, such as hearing aids or glasses, encourage proper nutrition and hydration, make sure they’re getting enough sleep. […] As a caregiver, you know your loved one best. While it’s not always possible to prevent delirium, you can aim to be a supportive and familiar presence in a hospital setting.

• #40 Delirium (sudden confusion) – How to help someone with delirium | Guy’s and St Thomas’ NHS Foundation Trust

  https://www.guysandstthomas.nhs.uk/health-information/delirium-sudden-confusion/how-help-someone-delirium

  It can be distressing to see someone that you know with delirium. There are things that family, friends and carers can do to help people when they are delirious. […] Sometimes withdrawal from these things can make delirium worse. The person may need specific treatments. […] It is helpful to visit the person with delirium as often as you can. You can talk to the nurses about coming outside of visiting hours. Seeing a familiar person can be reassuring for the person with delirium and help in their treatment. […] Delirium is distressing for everyone. However, when we have treated or managed the causes of delirium, the symptoms usually improve with time. […] Being at home again can help to make the person’s recovery from delirium quicker.

• #41 Delirium | MedlinePlus

  https://medlineplus.gov/delirium.html

  Treatment of delirium focuses on the causes and symptoms of delirium. The first step is to identify the cause. Often, treating the cause will lead to a full recovery. The recovery may take some time – weeks or sometimes even months. In the meantime, there may be treatments to manage the symptoms, such as: […] Medicines, including those that control aggression or agitation and pain relievers if there is pain. […] Treating the conditions that can cause delirium may reduce the risk of getting it. Hospitals can help lower the risk of delirium by avoiding sedatives and making sure that hospital rooms are kept quiet, calm, and well-lit. It can also help to have family members around and to have the same staff members treat the person each day (if possible).

• #42 Delirium – symptoms, diagnosis and treatment | healthdirect

  https://www.healthdirect.gov.au/delirium

  Delirium is a sudden change in the way you think and behave. […] Delirium is often caused by changes in your health, such as an infection or a medicine change. […] If you’re in hospital and at risk, your doctor will provide care to prevent delirium. […] Treatment for delirium focuses on finding and addressing the cause and providing supportive care. […] Your doctor may treat delirium by changing your prescription medicines, giving you intravenous fluids, prescribing antibiotics if you have an infection, and prescribing antipsychotic medicines when other methods to manage delirium don’t work. […] It can be reassuring for someone with delirium to see familiar faces. You may be encouraged to stay with your loved one if they are in hospital and have delirium. […] Delirium can be prevented with proper care. If you are at risk, your doctor may check your medicines and adjust those that may increase your risk, encourage you to eat and drink to stay hydrated and nourished, and help you stay active.

• #43 Alzheimer’s Disease and Delirium: Guidance and Tips

  https://www.webmd.com/alzheimers/confusion-delirium

  If a doctor has told you your loved one doesnt have delirium but is sundowning, try these things: Keep the home well-lit in the evening. Offer healthy food and drink later in the day. If you give them sweets and caffeine, do this in the morning. Try to have a large meal at lunch and keep the evening meal simple. Help them avoid nicotine and alcohol as much as possible. Plan activities in the early part of the day, and try not to let them nap in the afternoon. This will help them be relaxed later. Help them get regular exercise such as walking in the early part of the day. Pay attention to how tired you feel. If youre stressed by late afternoon, they may pick up on it and get agitated or confused in response. Try to figure out what is causing the increased confusion, anxiety, or agitation during the evening, and then make a plan to stay away from or stop these things. For example, if you think loud TV shows or too much activity could be the cause, try to cut down on these activities at night. Make a comfortable and safe area to sleep. Make sure the bedroom is at a comfortable temperature. Turn loud, distracting noises such as phones, stereos, or TVs down or off.

• #44 Delirium Treatment & Management: Approach Considerations, Medical Care, Consultations

  https://emedicine.medscape.com/article/288890-treatment

  A meta-analysis of 7 studies that focused on the usefulness of interventions such as physical or occupational therapy, daily reorientation, and the avoidance of sensorial deprivation found a significant reduction in the development of delirium among elderly inpatients. […] Psychiatric consultation may be indicated for management of behavioral problems such as agitation or aggressive behavior. […] Prevention should be the goal because delirium is associated with adverse outcomes and high healthcare costs. […] A multicomponent intervention study that targeted cognitive impairment, sleep deprivation, immobility, visual impairment, hearing impairment, and dehydration showed significant reduction in the number and duration of episodes of delirium in older patients who were hospitalized. […] Physicians should become familiar with prescribing practices for patients who are elderly, keeping dosages low and avoiding medications that cause delirium.

• #45 Confusion – symptoms, causes and prevention | healthdirect

  https://www.healthdirect.gov.au/confusion

  Confusion can be the sign of a serious medical condition. Call triple zero (000) and ask for advice if you (or someone you care for) experience a sudden onset of confusion or […] If somebody is suddenly confused, call triple zero (000) and ask for an ambulance. […] If confusion happens suddenly, it may be a sign of delirium. […] Sudden confusion or delirium can be caused by: dehydration or malnutrition, constipation or an inability to empty your bladder, severe pain, substances including sleeping pills, prescription medicines, heavy alcohol use or withdrawal from (stopping) alcohol, drugs or medicines, medical conditions such as infections, stroke or seizures, concussion, sleep deprivation, low blood sugar levels. […] You should see a doctor if you: are worried about changes in memory and cognitive function, suspect someone you care for is experiencing delirium, suspect you or someone you care for shows signs of dementia.

• #46 Treatment Options – Lewy Body Dementia Association

  https://www.lbda.org/treatment-options/

  Cholinesterase inhibitors are sometimes effective in treating hallucinations and other psychiatric symptoms of LBD. […] RBD can be quite responsive to treatment, so your physician may recommend a medication like melatonin and/or clonazepam. […] Be sure to meet with your anesthesiologist in advance of any surgery to discuss medication sensitivities and risks unique to LBD. People with LBD often respond to certain anesthetics and surgery with acute states of confusion or delirium and may have a sudden significant drop in functional abilities, which may or may not be permanent.

• #47 SOP: treatment of delirium | Neurological Research and Practice | Full Text

  https://neurolrespract.biomedcentral.com/articles/10.1186/s42466-021-00110-7

  Delirium is a frequent complication in hospitalised patients, often leading to difficulties in patient management and is associated with increased morbidity and mortality. […] The most important measures to prevent and treat delirium are recognition and removal of risk factors and causes. […] Although delirium is a very common and serious complication, evidence for pharmacological treatment is poor, and guidelines remain controversial. […] Accordingly, non-pharmacological treatments have gained increasing attention and should be applied. […] The treatment of delirium should encompass the elimination of potential causes and non-pharmacological interventions. Pharmacological treatment should be used in a time-limited manner and in the lowest possible dose for the management of highly stressful symptoms or high-risk behaviour.

• #48 Delirium – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK470399/

  The primary treatment for delirium is based on prevention and non-pharmacologic interventions because there are no FDA-approved medications for the treatment or prevention of delirium. The Hospital Elder Life Program (HELP) has been shown to reduce the incidence of delirium in elderly patients, falls, and overall healthcare costs. These interventions include identifying at-risk patients, decreasing environmental disturbances, increasing re-orientation interventions, and maximizing mobility. Pharmacological agents are used in cases of substance withdrawal-associated delirium, delirium at the end of life, and cases of hyperactive delirium where the patient’s behavior is a threat to themselves or others. There should be open communication between the interprofessional team members to ensure that the patient receives goal-directed treatment.

• #49 Delirium: Causes, Symptoms, Diagnosis and Treatment | Nationwide Children’s Hospital

  https://www.nationwidechildrens.org/conditions/delirium

  Delirium requires appropriate diagnosis and adequate treatment. […] Treating delirium starts with addressing the underlying causes or triggers. It may mean reducing the dosage or eliminating a medication until the delirium is resolved. It may mean treating an infection. When delirium is severe, a short course of medication is sometimes needed to help the brain recover fully. […] Delirium is usually a temporary condition. It is reversible when the underlying condition has been treated.

• #50 Delirium

  https://www.rwjbh.org/rwjbarnabas-health-ambulatory-care-center/treatment-care/senior-health/delirium/

  Delirium is a common, serious, and often preventable problem in hospitalized older adults. […] Delirium can slow the healing and recovery process and requires immediate treatment. […] Tell the nurse or doctor immediately if you notice any symptoms of delirium. Family members are often the first to notice subtle changes. […] Have a family member, caregiver, or friend stay with the delirious patient as much as possible. This is especially important when their confusion is severe. This will help reduce some of the anxiety caused by being in an unfamiliar place. […] Talk to your loved one about the delirious episode. This can help lessen the anxiety, fear, frustration, or anger that might otherwise develop.

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