[Treatment of hypoactive delirium: is there a place for antipsychotics?]

Hypoactive delirium is common among older hospitalised patients: between 29 and 64% of all older patients in hospital develop a delirium, of which the majority is of the hypoactive subtype. Hypoactive delirium often remains undiagnosed or is only diagnosed late and prognosis is worse than for a hyperactive delirium. Psychotic symptoms, fear, and distress are as frequent in hypoactive as in hyperactive delirium. The guideline of the Dutch College of General Practitioners and the multidisciplinary guideline of the Dutch Geriatrics Society differ in their advice on the pharmacological treatment of hypoactive delirium. Research into the effectiveness of antipsychotics so far did not differentiate between the different types of delirium. In patients with hypoactive delirium, antipsychotics should only be considered after all non-pharmacological options have been tried, no obvious and solvable cause for the delirium has been found and the patient is visibly suffering from the psychotic symptoms.