Delirium (acute brain failure or acute confusional state) is a clinical syndrome that is always due to a medical condition, usually more than one. A correct diagnosis of delirium is needed to offer treatment directed at the underlying cause(s). Hallmark symptoms of delirium (inattention, altered consciousness, disordered thinking, fluctuating mental state) can be overshadowed by psychosis and catatonia which can lead to a missed delirium diagnosis. This chapter reviews the clinical diagnosis of a delirium, its medical work-up, treatment (antipsychotics including intravenous haloperidol), and prevention. Psychiatric conditions that can be confused with a delirium or predispose to a delirium are discussed.
KeywordsDelirium Diagnosis Differential diagnosis Medical work-up Treatment Prevention Intravenous haloperidol
- 1.Quote Investigator. Available from: https://quoteinvestigator.com/2013/12/02/confuse-them/. Accessed on 7/1/2019.
- 12.Leentjens AF, Rundell J, Rummans T, Shim JJ, Oldham R, Peterson L, et al. Delirium: an evidence-based medicine (EBM) monograph for psychosomatic medicine practice, commissioned by the Academy of Psychosomatic Medicine (APM) and the European Association of Consultation Liaison Psychiatry and Psychosomatics (EACLPP). J Psychosom Res. 2012;73:149–52.CrossRefGoogle Scholar
- 14.Cassem NH, Murray GB. Delirious patients. In: Cassem NH, Stern TA, Rosenbaum JF, Jellinek MS, editors. Massachusetts General Hospital handbook of general hospital psychiatry. 4th ed. St. Louis: Mosby – Year Book, Inc.; 1997. p. 101–22.Google Scholar
- Caplan JP. Delirious patients. In: Stern TA, Freudenreich O, Smith FA, Fricchione GL, Rosenbaum JF, editors. Massachusetts General Hospital handbook of general hospital psychiatry. 7th ed. Edinburgh: Elsevier; 2018. p. 83–93. – From my department’s book on General Hospital Psychiatry. The CL service at MGH has extensive experience with the management of delirium, and this chapter contains detailed instructions about how to optimally treat a delirium, including IV haloperidol.Google Scholar
- Oldham MA, Flanagan NM, Khan A, Boukrina O, Marcantonio ER. Responding to ten common delirium misconceptions with best evidence: an educational review for clinicians. J Neuropsychiatry Clin Neurosci. 2018;30:51–7. – Readable and practical guide for clinicians that corrects commonly held misconceptions about delirium.CrossRefGoogle Scholar
- Stern TA, Celano CM, Gross AF, Huffman JC, Freudenreich O, Kontos N, et al. The assessment and management of agitation and delirium in the general hospital. Prim Care Companion J Clin Psychiatry. 2010;12:PCC 09r00938. – A clinical article about the diagnosis and treatment of agitation and delirium in the general medical hospital.PubMedPubMedCentralGoogle Scholar
- Wu YC, Tseng PT, Tu YK, Hsu CY, Liang CS, Yeh TC, et al. Association of delirium response and safety of pharmacological interventions for the management and prevention of delirium: a network meta-analysis. JAMA Psychiat. 2019;76:526–35. – If you like network meta-analyses, here are the results from one: haloperidol plus lorazepam worked best for the treatment of delirium, ramelteon for its prevention.CrossRefGoogle Scholar