Delirium

Delirium is a common life-threatening condition, suggestive of global organic cognitive dysfunction, which is the final common pathway for a number of insults. Inattention is the most common feature but disorientation, hallucinations, affective changes, and alterations in the sleep–wake cycle are also seen. The classical picture of the hyperactive wandering patient is less common than the withdrawn hypoactive presentation. Psychosis is equally likely in both groups and should be investigated. Many different assessment tools are available to assist in the diagnosis of delirium, though the most important step is to consider the diagnosis in the first place. Non-pharmacological interventions are vital; their aim is to minimize the impact of factors which predispose an individual to an episode of delirium. In established delirium, investigation and management of the underlying cause is crucial. Most drug treatment involves the use of antipsychotic medication, although the evidence is limited. Short-acting reversible benzodiazepines specifically target the anxiety experienced in delirium and thus may be useful if not contraindicated.