delirium

Q: In patients who develop delirium in ICU, their delusions and hallucinations should be challenged to orient them to reality? (select one)

A) True
B) False


Answer: B

We have learned that non-pharmacologic interventions works better in delirium particularly in ICU. It includes noise control, proper lightening, early mobilization, providing outside view (window), eye contact, availability of loved ones in the room, minimizing drug toxicities and many others. Although frequent reassurances is required but challenging their delusions and hallucinations may worsen delirium. They should neither be endorsed nor challenged.

#neurology
#psychiatry 


Further readings:

1. Fong TG, Tulebaev SR, Inouye SK. Delirium in elderly adults: diagnosis, prevention and treatment. Nat Rev Neurol. 2009;5(4):210–220. doi:10.1038/nrneurol.2009.24

2. O'Mahony R, Murthy L, Akunne A, et al. Synopsis of the National Institute for Health and Clinical Excellence guideline for prevention of delirium. Ann Intern Med 2011; 154:746. 

3. Hshieh TT, Yue J, Oh E, et al. Effectiveness of multicomponent nonpharmacological delirium interventions: a meta-analysis. JAMA Intern Med 2015; 175:512.