Delirium and Agitation

Delirium is a syndrome of altered state of consciousness and global cognitive impairment with diverse causes. It is common in the medically or surgically compromised patient and is associated with significant morbidity and mortality. The primary goal of treatment is to identify and correct the underlying cause of the delirium. Treatment includes protecting the patient from accidental self-harm, initiating pharmacotherapy to manage disruptive and dangerous behavior and symptoms of psychosis, and providing supportive and educational therapy for the patient and family. Physical restraints may need to be used for patients at immediate risk of injuring themselves or someone else until pharmacologic management can be initiated. Antipsychotics such as haloperidol with or without lorazepam are the treatment of choice. Environmental factors that may exacerbate delirium also need to be controlled. Patients should be reoriented and may benefit by having familiar or favorite objects present, such as family pictures. Sleep-wake disturbances must be corrected, and visual and auditory impairments must be addressed. Because family members can have a calming effect, provide frequent reorientation, and give the patient a sense of safety, family should be encouraged to be present if at all possible.