Delirium is a transient disorder of brain function. It manifests as a global cognitive impairment and behavioural disturbance.
It is more common at the extremes of life though it can occur at any age.
Incidence up to 15% has been reported
among general medical inpatients; up to 40% among acutely ill geriatric patients.
Poor detection and misdiagnosis are common.
The most common causes are:
- Metabolic derangements
- Side effects of drugs
- Disturbance of consciousness
- Memory deficits
- Language disturbances
- Perceptual disturbances
- Rapid fluctuations
- Disruption of sleep-wake cycle
- Psychomotor hyperactivity
- Mood alterations
- Acute (idiopathic) psychotic disorders
- Usually transient but may be associated with increased morbidity (e.g. from falls) and mortality
- Determined by any causal or contributing medical conditions
- Identify and ameliorate any causal or contributing medical conditions
- Normalize behaviour
- Improve cognition
- Nurse in a quiet, well-lit environment
- Support physical care, including food and fluid intake
- Provide orienting cues
- Physical restraint judiciously used when indicated
High-potency antipsychotics in low dosages for sedation
Adult: 0.5-1 mg orally or parenterally every 6 to 8 hours
- 2 – 12 years: initially 12.5 – 25 micrograms/kg orally twice daily, adjusted according to response to maximum 10 mg daily;
- 12 – 18 years: initially 0.5 – 3 mg daily, adjusted according to response to lowest effective maintenance dose (as low as 5-10 mg daily)
- For severe agitation (i.e. life-threatening features) or patient seriously disrupting management
- Give reassurance to patient and
- The transient nature of condition
- No risk of “madness”.
- Close nursing care is required to prevent injuries and falls
- Avoid over-medication, especially as antipsychotics and sedatives used may worsen delirium
- Early treatment of infective and metabolic conditions
- Care with the use of drugs (especially anticholinergic medications) in the elderly