DRUG-INDUCED DELIRIUM - INCIDENCE, MANAGEMENT AND PREVENTION

Drugs may be the most frequent single cause of delirium, and very ofte n they are a critical element in a multifactorial aetiology. While del irium may be precipitated by virtually any drug, certain classes of dr ugs are more commonly implicated. Effective management of drug-induced delirium involves recognition, cessation or dosage reduction of the c ausative drug(s), and initiation of reorientation strategies and suppo rtive medical care. Specific 'antidotes' are appropriate in only a few limited cases. Drug treatment aimed at sedation should be introduced for specific indications, such as aggression, risk of harm to self or others, hallucinations, patient distress, and where compliance with th erapy or procedures is essential. Certain benzodiazepines (diazepam, l orazepam, midazolam) and/or haloperidol may be the most appropriate ch oices in these circumstances. Primary prevention requires the prescrip tion of alternative lower risk medications and the minimisation of pol ypharmacy. Secondary prevention may be achieved through improved recog nition of the condition.