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 specific condition causing delirium. The person should be in a pleasant, comfortable, non-threatening, physically safe environment for diagnosis and initial care. Hospitalization may be required for a short time.

Stopping or changing medications that worsen confusion, or that are not essential to the care of the person, may improve cognitive functioning even before treatment of the underlying disorder. Medications that may worsen confusion include anticholinergics, analgesics, cimetidine, central nervous system depressants, lidocaine, and other medications (including alcohol and illegal drugs).

Disorders that contribute to confusion should be treated. These may include heart failure, decreased oxygen (hypoxia), excessive carbon dioxide levels (hypercapnia), thyroid disorders, anemia, nutritional disorders, infections, kidney failure, liver failure, and psychiatric conditions (such as depression). Correction of co-existing medical and psychiatric disorders often greatly improves mental functioning.

Medications may be required to control aggressive or agitated behaviors or behaviors that are dangerous to the person or to others. These are usually given in very low doses, with adjustment as required.

Medications that may be considered for use include:

• Thiamine
• Sedating medications such as clonazepam or diazepam
• Serotonin-affecting drugs (trazodone, buspirone)
• Dopamine blockers (such as haloperidol, olanzapine, Risperdal, clozapine)
• Fluoxetine, imipramine, Celexa (may help stabilize mood)

Sensory functioning should be evaluated and augmented as needed by the use of hearing aids, glasses, or cataract surgery.

Formal psychiatric treatment may be necessary. Behavior modification may be helpful for some people to control unacceptable or dangerous behaviors. This consists of rewarding appropriate or positive behaviors and ignoring inappropriate behaviors (within the bounds of safety). Reality orientation, with repeated reinforcement of environmental and other cues, may help reduce disorientation.