Delirium

Alternative names:

acute brain syndrome; acute confusional state

Treatment:

The goal of treatment is to control or reverse symptoms. Treatment varies with the specific condition causing delirium. The person should be in a pleasant, comfortable, nonthreatening, physically safe environment for diagnosis and initial treatment. Hospitalization may be required for a short time.

The cause should be identified and treated.

Stopping or changing medications that worsen confusion, or that are not essential to the care of the person, may improve cognitive functioning even before treatment of the underlying disorder. Medications that may worsen confusion include anticholinergics, analgesics, cimetidine, central nervous system depressants, lidocaine, and other medications.

Disorders that contribute to confusion should be treated. These may include heart failure, decreased oxygen (hypoxia), excessive carbon dioxide levels (hypercapnia), thyroid disorders, anemia, nutritional disorders, infections, kidney failure, liver failure, and psychiatric conditions such as depression. Correction of coexisting medical and psychiatric disorders often greatly improve mental functioning.

Medications may be required to control aggressive or agitated behaviors or behaviors that are dangerous to the person or to others. These are usually given in very low doses, with adjustment as required.

Medications that may be considered for use include:

• thiamine
• anti-psychotics, given at night
• beta-blockers if dementia is related to central nervous system lesions
• serotonin-affecting drugs (lithium, trazodone, buspirone, clonazepam)
• dopamine blockers (such as haloperidol)
• fluoxetine, imipramine (may help stabilize mood)
• cerebral vasodilators (variable results reported)
• stimulant drugs, may improve mood

Sensory functioning should be evaluated and augmented as needed by the use of hearing aids, glasses or cataract surgery.

Formal psychiatric treatment may be necessary. Behavior modification may be helpful for some people to control unacceptable or dangerous behaviors. This consists of rewarding appropriate or positive behaviors and ignoring inappropriate behaviors (within the bounds of safety). Reality orientation, with repeated reinforcement of environmental and other cues, may help reduce disorientation.

Expectations (prognosis):

The outcome varies. Acute disorders that cause delirium may coexist with chronic disorders that cause dementia. Acute brain syndromes may be reversible with treatment of the underlying cause. Delirium often lasts only about 1 week, although it may take several weeks for cognitive function to return to normal levels. Full recovery is common.

Complications:

• loss of ability to function or care for self
• loss of ability to interact
• may progress to stupor or coma
• side effects of medications used to treat the disorder
• other complications vary depending on the causative disorder

Calling your health care provider:

Call your health care provider if a rapid change in mental status occurs.