Psychiatric conditions 673

9tr^tmQnt of othor
• psychoactive drug use
• polypharmacy (>4 medications)
f anticholinergic drug use.
Outcome
Patients with delirium have an increased len k
increased risk of long-term institutional h°Spj?1 in^sed mortality and
patients with delirium range from 6% to Hospital 嘯初 rates of
In older people, the 1-year mortality rate ?re nvicc ^at of matched controls.5
Up to 60% of individuals suffer persistent cop - WKh Cascs of delirium is 35-40%?
these patients are also three times more lmPairment following delirium and
1Kely to develop dementia?-5
Management
Preventing delirium is the most effective strate^ f
cations.7 Delirium is a medical emergency lts ke”ncY compli-
underlying cause should be the first aimof ⑽ 砍咖⑽ °f
ev 二了^二?：：： nSr^etCgieS ShOUld bC inSd7ed —
^sonentaHo and gaining
be 山 reCted Ae underlying cause (if known) and then at the relief of specific
symptoms ot delirium.
The common errors the pharmacological management of delirium are to use
antipsychotic medications in excessive doses, to give them too late or to over-use
benzodiazepines.4
General principles of delirium managements^14
■ Keep the use of sedatives and antipsychotic medications to a minimum.
■ Use one drug at a time.
■ Tailor doses according to age, body size and degree of agitation.
■ Titrate doses to effect.
■ Use small doses regularly, rather than large doses less frequently.
■ Review at least every 24 hours. --..
■ Increase scheduled doses if regular ‘as needed’ doses are required after the initial

Choice of drug15-16 t t...

. rrpqrmencs for delirium are lacking, with avail-
High-quality trials of pharinacologi c nooulations and clinical outcomes, and
able studies often comprising heterogeneou p JviJence (o recommend any single
Producing conflicting results. There is insu 山⑻…inay derive less benefit from
drug treatment over others. Different p Carcr) Treatment choice should there-
^nipsychotic treatment (e.g. ^osc in Pa,^ * i(h coeXisnng medical conditions or
吣 be informed by rhe likelihood of "似⑻⑼
other medications (see Tabic 9. i )•
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