Approach to Managing Delirium

Diagnosis and Assessment

The American College of Physicians recommends that diagnosis should be made by a trained healthcare professional using clinical assessment based on DSM or ICD criteria 1, 2
If changes in cognitive or emotional behavior or psychomotor activity suggestive of delirium are present, a clinical assessment should be performed to confirm diagnosis 2, 3
Standardized tools like the Confusion Assessment Method (CAM) or CAM-ICU should be used for detection and monitoring 1

The European Society for Medical Oncology recommends identifying predisposing and precipitating factors through a comprehensive initial assessment 2, 3, 4
Common reversible causes to address include medications, infections, metabolic disturbances, opioid-induced neurotoxicity, pain, hypoxia, urinary retention, constipation, and dehydration 1, 2, 3, 4, 5
The American Geriatrics Society suggests treating hypercalcemia with bisphosphonates like IV pamidronate or zoledronic acid 2, 3
The American Geriatrics Society recommends providing magnesium replacement for hypomagnesemia 2, 3

The American College of Physicians recommends implementing environmental interventions, such as ensuring adequate lighting and clear signage, providing clock and calendar for orientation, minimizing room changes, and creating a calming environment 1, 5
The American College of Physicians suggests addressing cognitive impairment by regularly reorienting the patient, introducing cognitively stimulating activities, and facilitating regular visits from family and friends 1, 5
The American College of Physicians recommends ensuring adequate hydration and nutrition 1, 5
The American Academy of Sleep Medicine suggests implementing sleep hygiene measures to promote normal sleep-wake cycles 1

The American College of Physicians recommends that pharmacological interventions should be limited to patients with distressing symptoms or safety concerns 1
The American College of Physicians suggests avoiding haloperidol and risperidone as first-line agents for mild-to-moderate delirium 1
The American College of Physicians recommends considering olanzapine, quetiapine, or aripiprazole for moderate delirium symptoms requiring medication 1

The European Society for Medical Oncology recommends providing written information about delirium to family members, including definition, causes, symptoms, evolution, and management 6, 1
The European Society for Medical Oncology suggests offering guidance on appropriate responses and non-pharmacological interventions 6, 1
The American College of Physicians recommends providing educational and psychological support for families 1

The American College of Physicians recommends regularly reassessing mental status using standardized tools 1, 5
The American College of Physicians suggests monitoring for medication side effects, particularly extrapyramidal symptoms with antipsychotics 5
The American College of Physicians recommends adjusting treatment approaches based on symptom control and patient distress 1