Cases That Test Your Skills

Worsening agitation and hallucinations: Could it be PTSD?

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References

These preventive measures are important when treating delirium, such as minimizing Mr. G’s use of benzodiazepine and opioids—medications known to contribute to iatrogenic delirium.

A delirium diagnosis portends grave adverse outcomes. Research has shown significant associations with morbidity and mortality, financial and emotional burden, and prolonged hospitalizations. Often, symptoms of delirium persist for months and patients do not recover completely. However, studies have found that when underlying causes are treated effectively, delirium is more likely to be reversible.11

The prompt diagnosis of delirium with good interdisciplinary communication can reduce the risk of these adverse outcomes.12 Consultation-liaison psychiatrists are well positioned to facilitate the diagnoses of delirium and play a role in educating other health care providers of the importance of prevention, early symptom recognition, full workup, and effective treatment of its underlying causes.

Bottom Line

Delirium is a commonly encountered, life-threatening medical condition that requires prompt diagnosis and effective treatment. In patients who present with multi-factorial causes of altered mental status, it is important to cast a wide net, investigating all causes and treating each individually to improve patient outcomes.

Related Resources

  • Dasgupta M, Brymer C. Prognosis of delirium in hospitalized elderly: worse than we thought. Int J Geriatr Psychiatry. 2014;29(5):497-505.
  • Raj YP. Clearing up confusion. Current Psychiatry. 2015;14(3):18-21,28-31.

Drug Brand Names

Aripiprazole Abilify

Bupropion Wellbutrin
Chlorpromazine Thorazine
Citalopram Celexa
Clonazepam Klonopin
Cyclobenzaprine Flexeril
Dexamethasone Decadron
Docusate Colace
Enoxaparin Lovenox
Fluoxetine Prozac
Gabapentin Neurontin
Haloperidol Haldol
Hydromorphone Dilaudid
Levofloxacin Levaquin

Lidocaine ointment Xylocaine

Methadone Dolophine
Mirtazapine Remeron
Olanzapine Zyprexa
Omeprazole Prilosec
Ondansetron Zofran
Risperidone Risperdal
Tamsulosin Flomax
Trazodone Desyrel
Topiramate Topamax

Zolpidem Ambien

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