Delirium

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Central nervous system

Acute confusional state; Acute brain syndrome

The goal of treatment is to control or reverse the cause of the symptoms. Treatment depends on the condition causing delirium. Diagnosis and care should take place in a pleasant, comfortable, nonthreatening, physically safe environment. The person may need to stay in the hospital for a short time.

Stopping or changing medications that worsen confusion, or that are not necessary, may improve mental function significantly. Medications that may worsen confusion include:

• Alcohol
• Analgesics, especially narcotics such as codeine, hydrocodone, morphine, or oxycodone
• Anticholinergics
• Central nervous system depressants
• Cimetidine
• Illicit drugs
• Lidocaine

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Disorders that contribute to confusion should be treated. These may include:

• Anemia
• Decreased oxygen (hypoxia)
• Heart failure
• High carbon dioxide levels (hypercapnia)
• Infections
• Kidney failure
• Liver failure
• Nutritional disorders
• Psychiatric conditions (such as depression)
• Thyroid disorders

Treating medical and mental disorders often greatly improves mental function.

Medications may be needed to control aggressive or agitated behaviors. These are usually started at very low doses and adjusted as needed.

Medications include:

• Antidepresssants (fluoxetine, citalopram), if depression is present
• Dopamine blockers (haloperidol, quetiapine, or risperidone are most commonly used)
• Sedatives (clonazepam or diazepam) in cases of delirium due to alcohol or sedative withdrawal
• Thiamine

Some people with delirium may benefit from hearing aids, glasses, or cataract surgery.

Other treatments that may be helpful:

• Behavior modification to control unacceptable or dangerous behaviors
• Reality orientation to reduce disorientation

Acute conditions that cause delirium may occur with chronic disorders that cause dementia. Acute brain syndromes may be reversible by treating the cause.

Delirium often lasts only about 1 week, although it may take several weeks for mental function to return to normal levels. Full recovery is common.

• Loss of ability to function or care for self
• Loss of ability to interact
• Progression to stupor or coma
• Side effects of medications used to treat the disorder

Call your health care provider if there is a rapid change in mental status.

Review Date: 02/06/2010
Reviewed By: David C. Dugdale, III, MD, Professor of Medicine, Division of General Medicine, Department of Medicine, University of Washington School of Medicine; and Luc Jasmin, MD, PhD, Department of Neurolosurgery, Cedars-Sinai Medical Center, Los Angeles, and Department of Anatomy at UCSF, San Francisco, CA. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.

A.D.A.M., Inc. is accredited by URAC, also known as the American Accreditation HealthCare Commission (www.urac.org).