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9 - Delirium

from Part III - Specific treatments

Published online by Cambridge University Press:  12 May 2010

By
Laura Gage  and
David K. Conn
Edited by
Peter Tyrer  and
Kenneth R. Silk
Laura Gage
Affiliation:
Department of Psychiatry University of Toronto Toronto, ON Canada
David K. Conn
Affiliation:
University of Toronto Toronto, ON Canada
Peter Tyrer
Affiliation:
Imperial College of Science, Technology and Medicine, London
Kenneth R. Silk
Affiliation:
University of Michigan, Ann Arbor
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Summary

Editor's note

Delirium is one of the forgotten areas of therapeutics. It is observed frequently, often misinterpreted and misunderstood, but often mercifully disappears just as uncertainty about what to do gets stronger. This probably explains the relative paucity of evidence available about preferred treatments; delirium is a prelude to focused intervention rather than a clarion call for action. This chapter nonetheless indicates the beginnings of an evidence base for intervention that is of definite value.

Introduction

Delirium is associated with increased rates of mortality and medical complications, prolonged hospitalization, as well as cognitive and functional impairment. Symptoms of delirium can also cause significant distress and discomfort to both patients and their families. Unfortunately, delirium is commonly underdiagnosed by physicians. Recognition and appropriate treatment of delirium is essential to minimize associated morbidity.

The treatment of delirium is to tackle the underlying cause. Identifying underlying aetiologies and their correction should always be foremost in the clinician's mind. The common causes include infection, drug intoxication, renal or hepatic insufficiency, vascular disease affecting the brain, and electrolyte disturbance, and the prevalence of the condition varies from 10% in young hospitalized medical patients to 80% in those who are terminally ill (Brown & Boyle, 2002).

Delirium may cause agitation or psychotic symptoms, which puts patients or others at risk, affects their treatment, or may cause significant distress. In addition to environmental interventions, pharmacological treatment may be necessary to control these symptoms.

Antipsychotics have been the mainstay of treatment for agitation and psychotic symptoms in delirium.

Type
Chapter
Information
Cambridge Textbook of Effective Treatments in Psychiatry , pp. 173 - 186
Publisher: Cambridge University Press
Print publication year: 2008

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  • Delirium
    • By Laura Gage, Department of Psychiatry University of Toronto Toronto, ON Canada, David K. Conn, University of Toronto Toronto, ON Canada
  • Edited by Peter Tyrer, Imperial College of Science, Technology and Medicine, London, Kenneth R. Silk, University of Michigan, Ann Arbor
  • Book: Cambridge Textbook of Effective Treatments in Psychiatry
  • Online publication: 12 May 2010
  • Chapter DOI: https://doi.org/10.1017/CBO9780511544392.011
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  • Delirium
    • By Laura Gage, Department of Psychiatry University of Toronto Toronto, ON Canada, David K. Conn, University of Toronto Toronto, ON Canada
  • Edited by Peter Tyrer, Imperial College of Science, Technology and Medicine, London, Kenneth R. Silk, University of Michigan, Ann Arbor
  • Book: Cambridge Textbook of Effective Treatments in Psychiatry
  • Online publication: 12 May 2010
  • Chapter DOI: https://doi.org/10.1017/CBO9780511544392.011
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  • Delirium
    • By Laura Gage, Department of Psychiatry University of Toronto Toronto, ON Canada, David K. Conn, University of Toronto Toronto, ON Canada
  • Edited by Peter Tyrer, Imperial College of Science, Technology and Medicine, London, Kenneth R. Silk, University of Michigan, Ann Arbor
  • Book: Cambridge Textbook of Effective Treatments in Psychiatry
  • Online publication: 12 May 2010
  • Chapter DOI: https://doi.org/10.1017/CBO9780511544392.011
Available formats
×