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Delirium

A mental state in which a person is confused, disoriented, and not able to think or remember clearly. The person may also be agitated and have hallucinations.

PubMed Health Glossary
(Source: NIH - National Cancer Institute)

About Delirium

Delirium is a confused mental state that causes changes in awareness and behavior and may come and go during the day. A person with delirium may also have problems with

  • attention
  • thinking and memory
  • hallucinations, either hearing or seeing people or things that are not there
  • emotion
  • judgment
  • muscle control
  • sleeping and waking.

A person near the end of life may experience delirium. It is common in the last 24-48 hours of life due to organ failure.

Caring for someone with delirium

People with delirium can make a full recovery if the underlying cause is treatable and reversed. Creating a safe and soothing environment can help improve the course of delirium. You might try

  • keeping the room softly lit at night
  • turning off the television
  • removing other sources of excess noise and stimulation
  • checking for and treating fever (which can cause delirium).

The presence of a family member, friend, or a professional may reassure someone with delirium, preventing the need to medicate. Sedatives, sleeping medications, and other minor tranquilizers should be used sparingly unless the person is experiencing drug withdrawals. NIH - National Institute on Aging

What works? Research summarized

Evidence reviews

At this time, benzodiazepines cannot be recommended for the treatment of non‐alcohol related delirium

A systematic review of benzodiazepine treatment of non‐alcohol related delirium discovered very few trials (one randomized, controlled study of mechanically ventilated patients, and thus poorly reflective of delirious patients as a whole; and two partially controlled studies), the results of which indicate that at this time there is no evidence to support the use of benzodiazepines in the treatment of non‐alcohol withdrawal related delirium among hospitalised patients.

No convincing evidence from one trial of the efficacy of cholinesterase inhibitors for delirium

Delirium is a confusional state that is associated with physical illness. Its characteristic features are rapid onset, altered consciousness, reduced attention and global cognitive impairment. Other symptoms are hallucinations (particularly visual hallucinations), disturbed sleep pattern and agitation. Delirium is commonly found in hospital patients and is associated with longer admissions, poor functioning level, persistent cognitive impairment and need for institutional care. Delirium is therefore an important syndrome to recognise and treat. The one included trial, of donepezil compared with placebo in 15 patients, showed no statistically significant difference in length of delirium. No other outcomes were measured.

There is some evidence from RCTs that antipsychotics are effective, in varying doses, for different presentations of delirium

Haloperidol (<3.5 mg/d), risperidone, and olanzapine were equally effective in treating delirium, with few adverse effects. Parkinsonian adverse effects were common with higher dose haloperidol (>4.5 mg/d) compared with olanzapine. Pre‐operative haloperidol decreased severity and duration of post‐surgery delirium. All studies were small and should be repeated.

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Summaries for consumers

At this time, benzodiazepines cannot be recommended for the treatment of non‐alcohol related delirium

A systematic review of benzodiazepine treatment of non‐alcohol related delirium discovered very few trials (one randomized, controlled study of mechanically ventilated patients, and thus poorly reflective of delirious patients as a whole; and two partially controlled studies), the results of which indicate that at this time there is no evidence to support the use of benzodiazepines in the treatment of non‐alcohol withdrawal related delirium among hospitalised patients.

No convincing evidence from one trial of the efficacy of cholinesterase inhibitors for delirium

Delirium is a confusional state that is associated with physical illness. Its characteristic features are rapid onset, altered consciousness, reduced attention and global cognitive impairment. Other symptoms are hallucinations (particularly visual hallucinations), disturbed sleep pattern and agitation. Delirium is commonly found in hospital patients and is associated with longer admissions, poor functioning level, persistent cognitive impairment and need for institutional care. Delirium is therefore an important syndrome to recognise and treat. The one included trial, of donepezil compared with placebo in 15 patients, showed no statistically significant difference in length of delirium. No other outcomes were measured.

There is some evidence from RCTs that antipsychotics are effective, in varying doses, for different presentations of delirium

Haloperidol (<3.5 mg/d), risperidone, and olanzapine were equally effective in treating delirium, with few adverse effects. Parkinsonian adverse effects were common with higher dose haloperidol (>4.5 mg/d) compared with olanzapine. Pre‐operative haloperidol decreased severity and duration of post‐surgery delirium. All studies were small and should be repeated.

See all (27)

More about Delirium

Photo of an adult

Also called: Acute brain syndrome, Acute confusional state, Delirious

See Also: Dementia

Other terms to know:
Hallucinations

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