Abstract
Delirium (acute confusional state) is the most common neuropsychiatric syndrome affecting one third of older people during hospital stay. Although pathophysiological processes are not fully understood, delirium is a uniform manifestation of brain insults caused directly or through aberrant stress responses by vast array of metabolic, inflammatory, toxic or psychosocial factors.
Delirium is a medical emergency associated with increased morbidity and mortality. Early diagnosis and resolution of symptoms correlate with the most favorable outcomes.
Therefore, it is important to screen for delirium particularly in high risk elderly patients. Diagnosis should be confirmed using standardized instruments.
Prompt and thorough clinical and laboratory assessment help in recognizing delirium cause/s. Interventions to prevent and treat delirium should be complex (multimodal) targeting firstly the presumed cause/s.
Optimizing concurrent diseases and health conditions, ensuring calming environment, providing psychosocial support and optimize medication are efficient nonpharmacological interventions reducing delirium severity, duration and related complications. If used in prevention up to 35% of delirium cases could be avoided.
Lower level of evidence exists for pharmacological treatment which is reserved for patients at risk to causing harm to self or others. In these patients, low doses of antipsychotics are recommended.
Benzodiazepines are used to treat delirium related to alcohol withdrawal.