14th February 2025

Management of delirium

Management is generally supportive. Any contributing factors should be addressed, including alcohol or drug withdrawal. Medications should be reviewed, as some may worsen delirium, e.g. sedatives, opioids, antidepressants, steroids, stimulants, anti-Parkinson drugs or anticholinergics.

If it is unclear whether the diagnosis is delirium or dementia, treatment for delirium should be initiated first. If symptoms are ongoing, risk factors should be reviewed and a diagnosis of dementia considered.

Patients with delirium may have significant distress and pose a risk to themselves or others, in which case management should be escalated as follows:

• Start conservative: verbal and non-verbal communication with the aim of de-escalation
• If necessary and safe, use pharmacological measures: low-dose haloperidol, titrated up as necessary. Antipsychotic drugs should ideally be avoided in patients with Parkinson’s disease or Lewy body dementia

References

• National Institute for Health and Care Excellence. Delirium: prevention, diagnosis and management [Internet]. NICE. 2010 [cited 2022 Mar 1]. Available from: https://www.nice.org.uk/guidance/CG103
• Pisani M, Dosa DM. Assessment of delirium [Internet]. BMJ Best Practice. 2021 [cited 2022 Mar 1]. Available from: https://bestpractice.bmj.com/topics/en-gb/241