Rapid Clinical Updates: Delirium and Inpatient Psychotropics-Handout

Handout

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Delirium is a clinical syndrome marked by acute changes in attention, consciousness, and cognition, often presenting with psychomotor disturbances such as hyperactivity or hypoactivity, along with disrupted sleep patterns. It commonly affects older adults hospitalized for medical illnesses, with a prevalence ranging from 11% to 41%. Notably, 30-40% of delirium cases are preventable.<br /><br />Screening for delirium employs easy-to-use tools, with the Confusion Assessment Method (CAM) being the most widely adopted. Diagnosis via CAM requires identifying an acute onset and fluctuating course, inattention, plus either disorganized thinking or altered level of consciousness.<br /><br />Regarding treatment, antipsychotics have been used to manage delirium symptoms. However, studies show no significant mortality difference between haloperidol, ziprasidone, and placebo in delirium patients. Additionally, about 20% of intensive care patients treated with antipsychotics for delirium are discharged still receiving these medications, raising concerns about prolonged and potentially unnecessary use.<br /><br />Overall, delirium requires prompt recognition using validated screening tools and cautious use of antipsychotics, given the lack of mortality benefit and the risk of extended exposure post-discharge. Efforts toward prevention are critical since a large portion of delirium cases can be avoided through timely intervention and care strategies.<br /><br />References highlight key studies and reviews informing these findings, with the most recent update provided in March 2025.

Keywords

Delirium

Clinical syndrome

Attention deficit

Consciousness changes

Cognition impairment

Psychomotor disturbances

Confusion Assessment Method

Antipsychotics

Prevention

Hospitalized older adults