The article reviewed here is ‘Delirium: Sifting Through the Confusion’ by Raheel Khan and colleagues. In the introduction, the authors place delirium in context by presenting demographic and other data. The authors intention for the article is to discuss the causes and treatment of delirium.
They start with a case study and subsequently discuss this citing relevant references, and covering risk factors including polypharmacy, mechanical ventilation, opioids, benzodiazepines as well as a number of other precipitants from the case study. The first case is broken down into two further parts – but together forming a narrative structure. After each segment of the case is presented there is a discussion which cites widely from the literature. The authors state that there is no FDA approved treatment for delirium and then go on to consider the advantages and disadvantages of antipsychotic medications.
Table 2 in the paper is a very useful table which outlines some suggested advantages and disadvantages of medications that have been used in delirium.
In the second case, the presentation includes traumatic brain injury and the authors consider this in the subsequent discussion. They then look at the pharmacological treatment of delirium and in figure 2 there is a complex treatment pathway which looks at the management of hypoactive or hyperactive delirium (although I wasn’t able to identify mixed delirium). Along the way, the authors speculate about the different processes that may lead to delirium and form the beginnings of a pharmalogical rationale for approaching delirium while also recognising in ther final discussion the limitations in the field and the need for further research.
While relatively brief and necessarily case-based, I found the authors persuasive in their argument for a structured pharmacological approach to the treatment of delirium.
Raheel A.Khan, Debra Khan and James A. Bourgeouis. Delirium: Sifting Through the Confusion. Current Psychiatry Reports. 2009. 11. 226-234.
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