THE USE OF ENVIRONMENTAL STRATEGIES AND PSYCHOTROPIC MEDICATION IN THE MANAGEMENT OF DELIRIUM

Background. This paper examines the pattern and frequency of implement ation of environmental strategies and the use of psychotropic medicati on in the management of patients with delirium in an acute hospital se tting. Method. The study involved 46 consecutive referrals to a consul tation psychiatry service each of whom met ICD-10 criteria for deliriu m. Patients were subdivided into hyperactive, hypoactive and mixed sub types of delirium and assessed regarding severity of delirium, the use of psychotropic medication prior to consultation and the implementati on of environmental measures in their management. Results. Mean age wa s 60.1 years. Thirty per cent of patients were of the hyperactive subt ype, 24% hypoactive and 46% mixed. Psychotropic medication was given t o 56.5% prior to consultation and this is significantly associated wit h severity of delirium and in particular, with hyperactive delirium su btype. Of eight environmental strategies only four were instituted in over 50% of the patients prior to consultation. The application of the se strategies was associated with overall severity of delirium, agitat ion, mood lability and sleep-wake cycle disturbance. It was not signif icantly associated with severity of disorientation or with disturbed p erception/thinking. Conclusion. Simple environmental strategies such a s limiting changes in staff, minimising noise levels and involving rel atives in re-orientation are frequently overlooked in the management o f patients with delirium. Our study suggests that the implementation o f environmental strategies occurs primarily in response to behavioural challenges rather than to limit the core features of delirium.