PRACTICE GUIDELINE FOR THE Treatment of Patients With …

1 PRA CT ICE GU IDEL INE FO R TH E. Treatment of Patients With Delirium WORK GROUP ON DELIRIUM. Paula Trzepacz, , Chair William Breitbart, John Franklin, James Levenson, D. Richard Martini, Philip Wang, , (Consultant). Originally published in May 1999. This GUIDELINE is more than 5 years old and has not yet been updated to ensure that it reflects current knowledge and PRACTICE . In accordance with national standards, including those of the Agency for Healthcare Research and Quality's National GUIDELINE Clearinghouse ( ), this GUIDELINE can no longer be assumed to be current.

2 The August 2004 GUIDELINE Watch associated with this GUIDELINE provides Additional information that has become available since publication of the GUIDELINE , but it is not a formal update of the GUIDELINE . 1. Copyright 2010, American Psychiatric Association. APA makes this PRACTICE GUIDELINE freely available to promote its dissemination and use; however, copyright protections are enforced in full. No part of this GUIDELINE may be reproduced except as permitted under Sections 107 and 108 of Copyright Act. For permission for reuse, visit APPI Permissions & Licensing Center at AMERICAN PSYCHIATRIC ASSOCIATION.

3 STEERING COMMITTEE ON PRACTICE guidelines . John S. McIntyre, , Chair Sara C. Charles, , Vice-Chair Daniel J. Anzia, Ian A. Cook, Molly T. Finnerty, Bradley R. Johnson, James E. Nininger, Paul Summergrad, Sherwyn M. Woods, , Joel Yager, AREA AND COMPONENT LIAISONS. Robert Pyles, (Area I). C. Deborah Cross, (Area II). Roger Peele, (Area III). Daniel J. Anzia, (Area IV). John P. D. Shemo, (Area V). Lawrence Lurie, (Area VI). R. Dale Walker, (Area VII). Mary Ann Barnovitz, Sheila Hafter Gray, Sunil Saxena, Tina Tonnu, STAFF. Robert Kunkle, , Senior Program Manager Amy B.

4 Albert, , Assistant Project Manager Laura J. Fochtmann, , Medical Editor Claudia Hart, Director, Department of Quality Improvement and Psychiatric Services Darrel A. Regier, , , Director, Division of Research 2 APA PRACTICE guidelines Copyright 2010, American Psychiatric Association. APA makes this PRACTICE GUIDELINE freely available to promote its dissemination and use; however, copyright protections are enforced in full. No part of this GUIDELINE may be reproduced except as permitted under Sections 107 and 108 of Copyright Act. For permission for reuse, visit APPI Permissions & Licensing Center at CONTENTS.

5 Statement of Intent .. 5. Introduction .. 6. Development Process .. 7. I. Summary of Recommendations.. 9. A. Coding System .. 9. B. General Considerations .. 9. II. Disease Definition, Epidemiology, and Natural History .. 10. A. Definition and Clinical Features .. 10. B. Associated Features .. 12. C. Differential Diagnosis .. 12. D. Prevalence and Course .. 12. E. Causes .. 13. F. Use of Formal Measures .. 15. III. Treatment Principles and Alternatives .. 17. A. Psychiatric Management .. 17. B. Environmental and Supportive Interventions.

6 20. C. Somatic Interventions .. 22. IV. Formulation and Implementation of a Treatment Plan .. 27. A. Psychiatric Management .. 27. B. Choice of Specific Environmental and Supportive Interventions.. 28. C. Choice of Somatic Intervention .. 28. D. Issues of Competency and Consent .. 29. V. Clinical Features Influencing Treatment .. 30. A. Comorbid Psychiatric Disorders .. 30. B. Comorbid General Medical Conditions .. 30. C. Advanced Age .. 30. VI. Reviewers and Reviewing Organizations .. 31. VII. References .. 32. Treatment of Patients With Delirium 3.

7 Copyright 2010, American Psychiatric Association. APA makes this PRACTICE GUIDELINE freely available to promote its dissemination and use; however, copyright protections are enforced in full. No part of this GUIDELINE may be reproduced except as permitted under Sections 107 and 108 of Copyright Act. For permission for reuse, visit APPI Permissions & Licensing Center at Copyright 2010, American Psychiatric Association. APA makes this PRACTICE GUIDELINE freely available to promote its dissemination and use; however, copyright protections are enforced in full.

8 No part of this GUIDELINE may be reproduced except as permitted under Sections 107 and 108 of Copyright Act. For permission for reuse, visit APPI Permissions & Licensing Center at STATEMENT OF INTENT. The American Psychiatric Association (APA) PRACTICE guidelines are not intended to be con- strued 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 patient and are subject to change as sci- entific knowledge and technology advance and PRACTICE patterns evolve.

9 These parameters of PRACTICE should be considered guidelines only. Adherence to them will not ensure a successful outcome for every individual, nor should they be interpreted 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 psy- chiatrist in light of the clinical data presented by the patient and the diagnostic and Treatment options available. This PRACTICE GUIDELINE has been developed by psychiatrists who are in active clinical prac- tice.

10 In addition, some contributors are primarily involved in research or other academic endeavors. It is possible that through such activities some contributors, including work group members and reviewers, have received income related to treatments discussed in this guide- line. A number of mechanisms are in place to minimize the potential for producing biased recommendations due to conflicts of interest. Work group members are selected on the basis of their expertise and integrity. Any work group member or reviewer who has a potential con- flict of interest that may bias (or appear to bias) his or her work is asked to disclose this to the Steering Committee on PRACTICE guidelines and the work group.