Patients are often identified initially by law enforcement, but attempts to control individuals experiencing ExDS via physical, chemical, or electrical restraints are associated with an exceedingly high rate of morbidity and mortality. 2019;74(3):380-392. If agitation is the result of a medical condition or delirium, clinicians should attempt to treat the underlying cause instead of simply medicating. Anaesthesia.
Delirium is considered by some to be a specific type of confusional state that is characterized by increased vigilance along with psychomotor and autonomic overactivity and manifested as agitation, tremulousness, and hallucinations. Other medicines are also used, including benzodiazepines (these should be used only if the patient has alcohol or drug withdrawal). 3. Agitation is often a symptom of delirium, but some patients can become agitated without having delirium. Medicines for treating delirium symptoms include antipsychotic drugs (to treat agitation and hallucinations and to improve sensory problems). Avoid benzodiazepines in general, with certain very specific exceptions (chronic benzodiazepine use, status epilepticus). 2.
Agitation, agitated delirium and excited delirium are not diagnoses, but rather cardinal presentations of a variety of life-threatening underlying diagnoses. Although many clinicians think of patients with delirium as being agitated, hyperactive delirium represents only 25% of cases, with the others having hypoactive (“quiet”) delirium. Delirium is typically caused by a medical condition, substance intoxication, or medication side effect. Many patients develop delirium in the last few days of life which can cause agitation or restlessness and is sometimes called terminal restlessness or terminal agitation. The treatment of patients with delirium requires the consideration of many factors and cannot be adequately reviewed in a brief sum-mary. DO NOT treat agitated delirium with a benzodiazepine. Collect as much corroborating history as possible from police, family and any social supports. Anti-psychotics offer the theoretical pharmacological benefit in the management of ABD due to It may include attempts at violence, unexpected strength, and very high body temperature. Effectiveness of melatonin treatment on circadian rhythm disturbances in dementia. Managing delirium involves treating any reversible causes where appropriate, reviewing medication and providing a calm, safe and reassuring environment. Agitated individuals exhibit emotional distress along with excess motor activity, and verbal or physical aggression. Agitation and delirium are common problems in the cognitively impaired elderly. When we have a patient with agitated delirium who is at risk of impulsive actions resulting in falls, self-injurious behavior, dislodging medical devices (IV lines, PEG tubes, tracheostomy tubes, etc.
Excited delirium syndrome is a common yet poorly characterized ED presentation with a wide differential diagnosis. 16. de Jonghe A, Korevaar JC, van Munster BC, de Rooij SE. Antipsychotics are preferred over benzodiazepines in this situation. 12 (2017): 1161-74. Treatment of Patients With Delirium 9 I. More than 20% of patients in community or nursing home settings experience agitation. SUMMARY OF RECOMMENDATIONS The following executive summary is intended to provide an overview of the organization and scope of recommendations in this practice guideline.
Excited delirium (EXD), also known as agitated delirium, is a syndrome that presents with psychomotor agitation, delirium, and sweating. Mild to moderately agitated patients. These include: Haloperidol (Haldol®), Risperidone (Risperdal®), Olanzapine (Zyprexa®), and Quetiapine (Seroquel®). Benzodiazepines are preferred when agitation appears to be due to stimulant intoxication.