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cl:1-delirium [2019/08/25 18:46]
psychdb ↷ Links adapted because of a move operation
cl:1-delirium [2020/06/28 17:06] (current)
psychdb
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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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