Delirium (acute organic brain syndrome)

Question 1

DSM-5 criteria for diagnosis of delirium

Answer 1

A Disturbance of consciousness and awareness

B Clinical features appearing over a short period

C A change in cognition:

• perceptual disturbance
• incoherent speech
• disorientation
• memory impairment

DA & C not explained by another disorder

E Evidence of a cause

Question 2

Treatment principles

Answer 2

Acute delirium is a medical emergency.

Establish normal:

• hydration
• electrolyte balance
• and nutrition.

Question 3

Medication

Answer 3

may not be needed but will be in the presence of :

• anxiety
• aggression or
• psychotic symptoms.

Doses for a fit adult:

For anxiety and agitation:

• midazolam 1.25–5 mg IM

For psychotic behaviour (delusions or hallucinations):

• haloperidol 0.5 mg (o) as a single dose or
• olanzapine 2.5–10 mg (o) daily in 1 or 2 doses

For severe symptoms, when parenteral medication required:

• haloperidol 0.5 mg (IM) as single dose or
• olanzapine 2.5 mg (IM) as single dose (more sedating)

Oxygen if hypoxic

For anticholinergic delirium:

• tacrine hydrochloride 15–30 mg with caution by slow IV injection (an antidote)