Editing Delirium (section)

==Treatment==
Most often, delirium is reversible; however, people with delirium require treatment for the underlying cause(s), often to prevent injury and other poor outcomes directly related to delirium.<ref name="Burry_2019" />

Treatment of delirium requires attention to multiple domains including the following:<ref name="Delirium" /><ref name="Inouye2006" />
* Identify and treat the underlying medical disorder or cause(s)
* Addressing any other possible predisposing and precipitating factors that might be disrupting brain function
* Optimize physiology and conditions for brain recovery (e.g., oxygenation, hydration, nutrition, electrolytes, metabolites, medication review)
* Detect and manage distress and behavioral disturbances (e.g., pain control)
* Maintaining mobility
* Provide rehabilitation through cognitive engagement and mobilization
* Communicate effectively with the person experiencing delirium and their carers or caregivers
* Provide adequate follow-up including consideration of possible dementia and post-traumatic stress.<ref name="Delirium"/>

===Multidomain interventions===

These interventions are the first steps in managing acute delirium, and there are many overlaps with delirium preventative strategies.<ref name="Scottish_Intercollegiate_Guidelines_Network_2019" /> In addition to treating immediate life-threatening causes of delirium (e.g., low O{{sub|2}}, low blood pressure, low glucose, dehydration), interventions include optimizing the hospital environment by reducing ambient noise, providing proper lighting, offering pain relief, promoting healthy sleep-wake cycles, and minimizing room changes.<ref name="Scottish_Intercollegiate_Guidelines_Network_2019">{{Cite book|title=Risk reduction and management of delirium: a national clinical guideline |isbn=978-1-909103-68-9 |location=Edinburgh | publisher = Scottish Intercollegiate Guidelines Network |oclc=1099827664|year = 2019}}</ref> Although multicomponent care and comprehensive geriatric care are more specialized for a person experiencing delirium, several studies have been unable to find evidence showing they reduce the duration of delirium.<ref name="Scottish_Intercollegiate_Guidelines_Network_2019" />

Family, friends, and other caregivers can offer frequent reassurance, tactile and verbal orientation, cognitive stimulation (e.g. regular visits, familiar objects, clocks, calendars, etc.), and means to stay engaged (e.g. making hearing aids and eyeglasses readily available).<ref name="Inouye2006" /><ref name="NICE" /><ref>{{cite journal | vauthors = Rudolph JL, Marcantonio ER | title = Review articles: postoperative delirium: acute change with long-term implications | journal = Anesthesia and Analgesia | volume = 112 | issue = 5 | pages = 1202–1211 | date = May 2011 | pmid = 21474660 | pmc = 3090222 | doi = 10.1213/ANE.0b013e3182147f6d }}</ref> Sometimes verbal and non-verbal deescalation techniques may be required to offer reassurances and calm the person experiencing delirium.<ref name="NICE" /> Restraints should rarely be used as an intervention for delirium.<ref name="DeWitt_2018" /> The use of restraints has been recognized as a risk factor for injury and aggravating symptoms, especially in older hospitalized people with delirium.<ref name="DeWitt_2018" /> The only cases where restraints should sparingly be used during delirium is in the protection of life-sustaining interventions, such as endotracheal tubes.<ref name="DeWitt_2018">{{Citation| vauthors = DeWitt MA, Tune LE |title=Delirium|date=2018-07-06|work=The American Psychiatric Association Publishing Textbook of Neuropsychiatry and Clinical Neurosciences|publisher=American Psychiatric Association Publishing|doi=10.1176/appi.books.9781615372423.sy08|isbn=978-1-61537-187-7 |s2cid=240363328}}</ref>

Another approached called the "T-A-DA (''tolerate, anticipate, don't agitate'') method" can be an effective management technique for older people with delirium, where abnormal behaviors (including hallucinations and delusions) are tolerated and unchallenged, as long as caregiver safety and the safety of the person experiencing delirium is not threatened.<ref name="Oh_2017"/> Implementation of this model may require a designated area in the hospital. All unnecessary attachments are removed to anticipate for greater mobility, and agitation is prevented by avoiding excessive reorientation/questioning.<ref name="Oh_2017"/>

===Medications===

The use of medications for delirium is generally restricted to managing its distressing or dangerous neuropsychiatric disturbances. Short-term use (one week or less) of low-dose [[haloperidol]] is among the more common pharmacological approaches to delirium.<ref name="Inouye2006" /><ref name="NICE" /> Evidence for effectiveness of [[atypical antipsychotic]]s (e.g. [[risperidone]], [[olanzapine]], ziprasidone, and [[quetiapine]]) is emerging, with the benefit for fewer side effects<ref name="Inouye2006" /><ref>{{cite book| vauthors = Tyrer PJ, Silk KR |title=Cambridge Textbook of Effective Treatments in Psychiatry |date=2008 |publisher=Cambridge University Press |isbn=9780511393020 |location=Leiden |oclc=437204638}}</ref> Use antipsychotic drugs with caution or not at all for people with conditions such as [[Parkinson's disease]] or [[dementia with Lewy bodies]].<ref name = NICE /> Evidence for the effectiveness of medications (including [[antipsychotic]]s and [[benzodiazepine]]s) in treating delirium is weak.<ref name="Soiza_2019">{{cite journal | vauthors = Soiza RL, Myint PK | title = The Scottish Intercollegiate Guidelines Network (SIGN) 157: Guidelines on Risk Reduction and Management of Delirium | journal = Medicina | volume = 55 | issue = 8 | pages = 491 | date = August 2019 | pmid = 31443314 | pmc = 6722546 | doi = 10.3390/medicina55080491 | doi-access = free }}</ref><ref name="Burry_2019" />

Benzodiazepines can cause or worsen delirium, and there is no reliable evidence of efficacy for treating non-anxiety-related delirium.<ref name="Challenges of Delirium Management i">{{cite journal | vauthors = Roberson SW, Patel MB, Dabrowski W, Ely EW, Pakulski C, Kotfis K | title = Challenges of Delirium Management in Patients with Traumatic Brain Injury: From Pathophysiology to Clinical Practice | journal = Current Neuropharmacology | volume = 19 | issue = 9 | pages = 1519–1544 | date = 2021-09-14 | pmid = 33463474 | pmc = 8762177 | doi = 10.2174/1570159X19666210119153839 }}</ref> Similarly, people with [[dementia with Lewy bodies]] may have significant side effects with antipsychotics, and should either be treated with a none or small doses of benzodiazepines.<ref name="NICE" />

The antidepressant [[trazodone]] is occasionally used in the treatment of delirium, but it carries a risk of over-sedation, and its use has not been well studied.<ref name=Inouye2006/>

For adults with delirium that are in the ICU, medications are used commonly to improve the symptoms. [[Dexmedetomidine]] may shorten the length of the delirium in adults who are critically ill, and [[rivastigmine]] is not suggested.<ref name="Burry_2019" /> For adults with delirium who are near the end of their life (on palliative care) high quality evidence to support or refute the use of most medications to treat delirium is not available.<ref name="Finucane_2020">{{cite journal | vauthors = Finucane AM, Jones L, Leurent B, Sampson EL, Stone P, Tookman A, Candy B | title = Drug therapy for delirium in terminally ill adults | journal = The Cochrane Database of Systematic Reviews | volume = 1 | issue = 1 | pages = CD004770 | date = January 2020 | pmid = 31960954 | pmc = 6984445 | doi = 10.1002/14651858.CD004770.pub3 }}</ref> Low quality evidence indicates that the [[antipsychotic medication]]s risperidone or haloperidol may make the delirium slightly worse in people who are terminally ill, when compared to a [[placebo]] treatment.<ref name="Finucane_2020" /> There is also moderate to low quality evidence to suggest that haloperidol and risperidone may be associated with a slight increase in side effects, specifically [[Extrapyramidal symptoms|extrapyramidal]] symptoms, if the person near the end of their life has delirium that is mild to moderate in severity.<ref name="Finucane_2020" />