Delirium is not a disease, but a syndrome (i.e. collection of symptoms) indicating dysfunction of the brain, in the same way shortness of breath describes dysfunction of the respiratory system, but does not identify the disorder.
Treatment of delirium involves two main strategies.
First, treatment of the underlying presumed acute cause or causes.
Second, optimising conditions for the brain. This involves ensuring that the patient with delirium has adequate oxygenation, hydration, nutrition, and normal levels of metabolites, that drug effects are minimised, constipation treated, pain treated, and so on.
Detection and management of mental stress is also very important. Thus, the traditional concept that the treatment of delirium is 'treat the cause' is not adequate; patients with delirium actually require a highly detailed and expert analysis of all the factors which might be disrupting brain function.
The first line choice of pharmacological treatment for delirium depends on its cause.
Antipsychotics are the most commonly used drugs for delirium and the most studied. Benzodiazepines themselves can cause delirium or worsen it and are generally ineffective for most causes of delirium; however, if delirium is due to sedative-hypnotic withdrawal, e.g. alcohol withdrawal or benzodiazepine withdrawal or the patient cannot take antipsychotics (e.g. in Parkinson's disease then benzodiazepines are recommended and the most effective treatment.
Palliative or symptomatic treatment of delirium is sometimes necessary to make a patient comfortable.
Antipsychotics, preferably those with minimal anticholinergic activity, such as haloperidol or risperidone may be preferred.
Other evidence also suggests that non-pharmacological measures may also be effective in decreasing the incidence of delirium.
Because delirium is a mere symptom of another problem which may be very subtle, the wisdom of treatment of the delirious patient with drugs must overcome natural skepticism, and requires a high degree of skill.
There have been reports that cholinesterase inhibitors might be effective in treating delirium, but there is little evidence for this.
Further Reading
This article is licensed under the Creative Commons Attribution-ShareAlike License.
It uses material from the Wikipedia article on
"Delirium"
All material adapted used from Wikipedia is available under the terms of the
Creative Commons Attribution-ShareAlike License.
Wikipedia® itself is a registered trademark of the Wikimedia Foundation, Inc.