- Last edited on February 1, 2024
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<panel type="info" title="Delirium Risk Factors" no-body="true"> | <panel type="info" title="Delirium Risk Factors" no-body="true"> | ||
- | ^ Modifiable Essentials ^ Modifiable Medical ^ Non-modifiable ^ | + | ^ Modifiable Essentials ^ Modifiable Medical ^ Non-modifiable ^ |
- | | • Sensory impairment (hearing or vision)\\ • Immobilization (catheters or restraints)\\ • Environment (for example, admission to an intensive care unit)\\ • [[pain-medicine:home|Pain]]\\ • Emotional distress\\ • Sustained sleep deprivation | • Medications (e.g. - [[addictions:sedative-hypnotics|sedative hypnotics]], narcotics, [[meds:toxidromes:anticholinergic-cholinergic|anticholinergic]] drugs, corticosteroids, polypharmacy, **[[addictions:alcohol|alcohol withdrawal]]** or other drugs)\\ • Acute neurological diseases (e.g. - acute stroke [usually right parietal], intracranial hemorrhage, meningitis, [[cl:0-autoimmune-encephalitis|encephalitis]])\\ • Ongoing illness (e.g. - infection, iatrogenic complications, acute illness, anemia, dehydration, poor nutrition, trauma, fractures, HIV)\\ • Metabolic derangement\\ • Surgery | • [[geri:dementia:home|Dementia]] or cognitive impairment\\ • Advancing age (>65 years)\\ • History of delirium, stroke, neurological disease, falls or gait disorder\\ • Multiple comorbidities\\ • Male sex\\ • Chronic renal or hepatic disease | | + | | • Sensory impairment (hearing or vision)\\ • Immobilization (catheters or restraints)\\ • Environment (for example, admission to an intensive care unit)\\ • [[pain-medicine:home|Pain]]\\ • Emotional distress\\ • Sustained sleep deprivation | • Medications (e.g. - [[addictions:sedative-hypnotics|sedative hypnotics]], narcotics, [[meds:toxidromes:anticholinergic-cholinergic|anticholinergic]] drugs, corticosteroids, polypharmacy, **[[addictions:alcohol|alcohol withdrawal]]** or other drugs)\\ • Acute neurological diseases (e.g. - acute stroke [usually right parietal], intracranial hemorrhage, meningitis, [[cl:0-autoimmune-encephalitis|encephalitis]])\\ • Ongoing illness (e.g. - **infection** (UTI), iatrogenic complications, acute illness, anemia, **dehydration** (often giving IV fluids will improve things), poor nutrition, trauma, fractures, HIV)\\ • Metabolic derangement\\ • Surgery | • [[geri:dementia:home|Dementia]] or cognitive impairment\\ • Advancing age (>65 years)\\ • History of delirium, stroke, neurological disease, falls or gait disorder\\ • Multiple comorbidities\\ • Male sex\\ • Chronic renal or hepatic disease | |
</panel> | </panel> | ||
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<callout icon="true" type="warning">Don't forget to order a baseline ECG for a [[meds:qtc|QTc]], especially if you are starting out with haloperidol.</callout> | <callout icon="true" type="warning">Don't forget to order a baseline ECG for a [[meds:qtc|QTc]], especially if you are starting out with haloperidol.</callout> | ||
- | Most studies have shown that haloperidol (at doses < 3.5 mg daily), risperidone, and olanzapine were all equally effective in treating delirium. There is no evidence that //prophylactic// pharmacologic treatment works.[([[https://jamanetwork.com/journals/jama/article-abstract/2673149?redirect=true|van den Boogaard, M., Slooter, A. J., Brüggemann, R. J., Schoonhoven, L., Beishuizen, A., Vermeijden, J. W., ... & Van der Voort, P. H. (2018). Effect of Haloperidol on Survival Among Critically Ill Adults With a High Risk of Delirium: The REDUCE Randomized Clinical Trial. JAMA, 319(7), 680-690.]])] There is some emerging evidence that [[meds:melatonin-agonist:melatonin|melatonin]] and melatonin agonists may be effective in the prevention and management of delirium.[([[https://www.ncbi.nlm.nih.gov/pubmed/20845391|Al‐Aama, T., Brymer, C., Gutmanis, I., Woolmore‐Goodwin, S. M., Esbaugh, J., & Dasgupta, M. (2011). Melatonin decreases delirium in elderly patients: a randomized, placebo‐controlled trial. International journal of geriatric psychiatry, 26(7), 687-694.]])][([[https://www.ncbi.nlm.nih.gov/pubmed/24554232|Hatta, K., Kishi, Y., Wada, K., Takeuchi, T., Odawara, T., Usui, C., & Nakamura, H. (2014). Preventive effects of ramelteon on delirium: a randomized placebo-controlled trial. JAMA psychiatry, 71(4), 397-403.]])] | + | Most studies have shown that haloperidol (at doses < 3.5 mg daily), risperidone, and olanzapine were all equally effective in managing delirium. There is no evidence that prophylactic or preventative pharmacologic treatment works.[([[https://jamanetwork.com/journals/jama/article-abstract/2673149?redirect=true|van den Boogaard, M., Slooter, A. J., Brüggemann, R. J., Schoonhoven, L., Beishuizen, A., Vermeijden, J. W., ... & Van der Voort, P. H. (2018). Effect of Haloperidol on Survival Among Critically Ill Adults With a High Risk of Delirium: The REDUCE Randomized Clinical Trial. JAMA, 319(7), 680-690.]])][([[https://www.ncbi.nlm.nih.gov/pubmed/31476766|Oh, E. S., Needham, D. M., Nikooie, R., Wilson, L. M., Zhang, A., Robinson, K. A., & Neufeld, K. J. (2019). Antipsychotics for Preventing Delirium in Hospitalized Adults. Annals of internal medicine, 171(7), 474-484.]])] There is some emerging evidence that [[meds:melatonin-agonist:melatonin|melatonin]] and melatonin agonists may be effective in the prevention and management of delirium.[([[https://www.ncbi.nlm.nih.gov/pubmed/20845391|Al‐Aama, T., Brymer, C., Gutmanis, I., Woolmore‐Goodwin, S. M., Esbaugh, J., & Dasgupta, M. (2011). Melatonin decreases delirium in elderly patients: a randomized, placebo‐controlled trial. International journal of geriatric psychiatry, 26(7), 687-694.]])][([[https://www.ncbi.nlm.nih.gov/pubmed/24554232|Hatta, K., Kishi, Y., Wada, K., Takeuchi, T., Odawara, T., Usui, C., & Nakamura, H. (2014). Preventive effects of ramelteon on delirium: a randomized placebo-controlled trial. JAMA psychiatry, 71(4), 397-403.]])] |
<panel type="info" title="Pharmacological Management of Delirium" no-body="true"> | <panel type="info" title="Pharmacological Management of Delirium" no-body="true"> | ||
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===== Resources ===== | ===== Resources ===== | ||
+ | <WRAP group> | ||
+ | <WRAP half column> | ||
== For Providers == | == For Providers == | ||
* [[https://ccsmh.ca/national-guidelines-for-seniors-mental-health-project/|2014 CCSMH Guideline Update - Canadian Coalition for Seniors Mental Health]] | * [[https://ccsmh.ca/national-guidelines-for-seniors-mental-health-project/|2014 CCSMH Guideline Update - Canadian Coalition for Seniors Mental Health]] | ||
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* [[http://www.bcmj.org/articles/delirium-older-adults-diagnosis-prevention-and-treatment|Wan, M., & Chase, J. M. (2017). Delirium in older adults: Diagnosis, prevention, and treatment. British Columbia Medical Journal, 59(3), 165-170.]] | * [[http://www.bcmj.org/articles/delirium-older-adults-diagnosis-prevention-and-treatment|Wan, M., & Chase, J. M. (2017). Delirium in older adults: Diagnosis, prevention, and treatment. British Columbia Medical Journal, 59(3), 165-170.]] | ||
* [[https://www.pogoe.org/ask/antipsychotics|POGOe: What is the best choice of antipsychotic medications for delirium in the hospitalized elderly patient?]] | * [[https://www.pogoe.org/ask/antipsychotics|POGOe: What is the best choice of antipsychotic medications for delirium in the hospitalized elderly patient?]] | ||
+ | </WRAP> | ||
+ | <WRAP half column> | ||
+ | == Articles == | ||
+ | * [[https://www.nytimes.com/2020/06/28/health/coronavirus-delirium-hallucinations.html|NYT: ‘They Want to Kill Me’: Many Covid Patients Have Terrifying Delirium]] | ||
+ | </WRAP> | ||
+ | </WRAP> | ||
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