Geriatria

TREATING DELIRIUM
A Quick Reference Guide

American Psychiatric Association
Steering Committee on Practice Guidelines
John S. McIntyre, M.D., Chair
Sara C. Charles, M.D., Vice-Chair
Kenneth Altshuler, M.D.
Ian Cook, M.D.
C. Deborah Cross, M.D.
Lisa Mellman, M.D.
Louis Alan Moench, M.D.
Grayson Norquist, M.D.
Stuart W. Twemlow, M.D.
Sherwyn Woods, M.D., Ph.D.
Joel Yager, M.D.Area and Component Liaisons
Ellen R. Fischbein, M.D. (Area I)
James Nininger, M.D. (Area II)
Roger Peele, M.D. (Area III)
Daniel J. Anzia, M.D. (Area IV)
R. Scott Benson, M.D. (Area V)
Lawrence Lurie, M.D. (Area VI)
R. Dale Walker, M.D. (Area VII)
Kathleen Askland, M.D. (Fellow)
Sheila Hafter Gray, M.D. (Liaison)
Rupang Pandya, M.D. (Fellow)
Konasale Prasad, M.D. (Fellow)

MedicalEditor, Quick Reference Guides
Michael B. First, M.D.
Staff
Robert Kunkle, M.A., Senior Program Manager
Claudia Hart, Director, Department of Quality Improvement
and Psychiatric Services
Laura J. Fochtmann, M.D., Medical Editor, Practice Guidelines
Darrel Regier, M.D., M.P.H., Director, Division of Research

TREATING DELIRIUM
A Quick Reference Guide

Based on Practice Guideline for theTreatment of Patients With Delirium,
originally published in May 1999. A guideline watch, summarizing significant developments
in the scientific literature since publication of this guideline, may be available in the
Psychiatric Practice section of the APA web site at www.psych.org.
1

For Continuing Medical Education credit
for APA Practice Guidelines,
visit www.psych.org/cme.
To orderindividual Practice Guidelines or the
2004 Compendium of APA Practice Guidelines,
visit www.appi.org or call 800-368-5777.

The American Board of Psychiatry and Neurology (ABPN) has reviewed
the APA Practice Guidelines CME Program and has approved
this product as part of a comprehensive lifelong learning program,
which is mandated by the American Board of Medical Specialties
as a necessarycomponent of maintenance of certification.
ABPN approval is time limited to 3 years for each individual Practice Guideline CME course.
Refer to APA’s CME web site for ABPN approval status of each course.

TREATING DELIRIUM • 3

Introduction
“Treating Delirium: A Quick Reference Guide” is a summary and synopsis of the American Psychiatric Association’s Practice Guideline for the
Treatment ofPatients With Delirium, which was published in The
American Journal of Psychiatry in May 1999 and is available through
Americian Psychiatric Publishing, Inc. The Quick Reference Guide is not
designed to stand on its own and should be used in conjunction with the
full text of the Practice Guideline. Algorithms illustrating the treatment of
delirium are included.

Statement of Intent
ThePractice Guidelines and the Quick Reference Guides are not intended to be construed or to serve as a standard of medical care. Standards
of medical care are determined on the basis of all clinical data available
for an individual case and are subject to change as scientific knowledge
and technology advance and practice patterns evolve. These parameters
of practice should be considered guidelinesonly. Adherence to them will
not ensure a successful outcome in every case, nor should they be construed as including all proper methods of care or excluding other acceptable methods of care aimed at the same results. The ultimate judgment
regarding a particular clinical procedure or treatment plan must be made
by the psychiatrist in light of the clinical data presented by the patient
and thediagnostic and treatment options available.
The development of the APA Practice Guidelines and Quick Reference
Guides has not been financially supported by any commercial organization.

4 • TREATING DELIRIUM

OUTLINE
A. Diagnosis and
Assessment
1. Diagnosis of
Delirium ............5
2. Assessment of
Clinical Status ....5

C. Environmental
and Supportive
Interventions
1....