APA has published an all-new clinical practice guideline on the prevention and treatment of delirium. Developed by a multidisciplinary workgroup, the new guideline is intended for use by any clinician who may encounter delirium in their scope of practice.
“Having a psychiatrically informed clinical practice guideline is essential—and has profound psychiatric import—because a diagnosis of delirium excludes pretty much every other psychiatric diagnosis,” said workgroup member Mark A. Oldham, M.D., of the University of Rochester Medical Center.
The practice guideline includes 12 clinical recommendations and three suggestions related to assessment and treatment planning, pharmacological and non-pharmacological interventions, and transitions of care. Among these are the recommendation that antipsychotic medications should not be used to prevent delirium or hasten its resolution. These medications can be used to address neuropsychiatric symptoms of delirium such as agitation, but only if the symptoms cause significant distress and other de-escalation strategies haven’t worked.
Another key message is to ensure that people with or at-risk of delirium receive positive daytime stimulation, such as spending time with family, and the proper nighttime environment to facilitate sleep. “We emphasize these because we recognize that they are not being done consistently,” Oldham said. “We want to drive home, based on really sound data, the importance of these nonpharmacological interventions across the board for promoting healthy cognition while hospitalized.”
Read more about the development of the delirium practice guideline in the September issue of Psychiatric News, available now online. The current issue also includes a Special Report on antidepressant withdrawal, an “Ethics Corner” column on the complicated issue of involuntary hospitalization, and more.
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