Treatment for Delirium

Delirium may occur in any stage of life and may manifest in many ways. An episodic or acute onset of delirium is often described and thought to be a normal developmental response that may occur as a result of stress, illness or treatment, and the impact of its presence remains to be realised. Early awareness of delirium is vital to maintain the patients status, and its prevention and treatment are important. The key is to identify the predisposing factors that are responsible for the development or aggravation of delirium - the risk factors, especially the 'dysregulation of arousal system in delirium.

The authors of this study did not find any unequivocal signs of delirium in patients being discharged from hospital to the post-acute wards of their hospitals. However, when considering those patients discharged to the post-acute wards, patients should be aware of a variety of signs and symptoms of delirium. These include: changes in arousal, attention span, and memory. There is a need for further work, on the definition of delirium and its clinical usefulness, as well as other clinical guidelines for the assessment and referral of delirium. Results from a recent clinical trial highlights the importance of this area of study.

Dementia in the elderly is multifactorial and associated with a variety of psychiatric and metabolic disturbances. The high prevalence of depression and psychosocial stress-related symptoms observed in patients with delirium may explain these connections. These links between delirium and dementia may help us understand the etiology of dementia.

Although the prevalence of delirium was similar for older adults without dementia and those with dementia, the likelihood of experiencing delirium was significantly greater for those with dementia. Thus, delirium may be more a problem for older adults with dementia than for those without dementia. The strongest independent predictors of having delirium were the same as for having dementia. Recent findings highlight the need for further research into the risk factors for delirium among older adults.

Delirium is not a cure for dementia and in most respects does not need to be treated, but good quality palliative care and early detection may result in better quality of life in older people.

There is significant over-prescribing of sedation use in patients with delirium in nursing homes and general hospitals. Appropriate use of sedatives may lessen delirium symptomatology, shorten length of stay, and enhance patient safety.

Delirium is highly prevalent in ICU patients and is a substantial barrier to the recovery of these patients. The management of delirium is the cornerstone of care in patients recovering from critical illness. Pharmacological agents are used as first line treatment based on high-quality evidence, whilst psychological therapies are used more systematically to manage the patient more socially with the family. Physical therapists can play an important role with respect to pain, particularly the care of skin burns, in addition to physiotherapy or occupational therapy.

In a recent study, findings focused on delirium research but it will add to the knowledge base for this topic. However, we recommend that future research should examine patients carefully because the prevalence and consequences of postoperative delirium would be a serious problem in any hospital, regardless of the type of surgery.

Based on the review of the literature, there is neither evidence nor evidence that the treatment of insomnia and antipsychotic medications in psychosis result in significant effectiveness for any of the reviewed variables. The reviews also reported insufficient levels of evidence that treatment is more effective than a placebo for the reviewed variables except for improvement on the psychosocial variables. The treatment of insomnia may have some effect on psychoses but there was inadequate evidence. These were considered to be not conclusive evidence that treatment is more effective than a placebo.

Findings from a recent study of older persons (mean age 80 years), delirium is associated with a 2-month higher mortality than in the control group. More than a third of persons with delirium survived 1 year. Mortality risk appeared higher among those with longer delirium length (>3 days) vs <3 days, and for males vs females.

On average, people with delirium who were hospitalized had an age of 93.1 at presentation and a lifetime risk of dementia of 0.56. The prevalence of delirium was 7.1% in the inpatient group and 11.4% in the community. These rates of delirium in older patients hospitalized because of an acute disease are higher than those previously reported.