Assessment and management of the acutely confused patient

Acute confusional state, or delirium, is a transient disorder of brain function with core features of impairment of consciousness with attentional deficit, other cognitive alterations, and a relatively rapid onset of the disorder with a characteristically fluctuating course. Recognition and appropriate evaluation and treatment of delirium is important to decrease the substantial morbidity and mortality associated with it. Delirium is a syndrome reflecting brain dysfunction that is almost always due to identifiable systemic or cerebral disease or to drug intoxication or withdrawal. The key to treating delirium is to identify and ameliorate any causal or contributing medical conditions. The use of psychoactive drugs should be minimized, although low-dose antipsychotics can be used to decrease psychomotor agitation if indicated. Keeping the patient in an environment that is quiet and free of unnecessary stimulation, providing extra supportive physical care, with maintenance of basic functions such as food and fluid intake, is essential.