Environmental and supportive interventions: These interventions are recommended for all patients with delirium, on the basis of some formal evidence but mainly because of the value observed through clinical experience and the absence of adverse effects.
Somatic interventions: Evidence for the efficacy of
antipsychotics in treating delirium has come from numerous case reports and
uncontrolled trials. A series of controlled trials also showed that
antipsychotic medications can be used to treat agitation and psychotic symptoms
in medically ill and geriatric patient populations. A randomized, double-blind
comparison trial identified delirium by using standardized clinical measures and
demonstrated the clinical superiority of antipsychotic medications over
benzodiazepines in delirium treatment. Two double-blind clinical trials
comparing droperidol to haloperidol suggested that a more rapid response may be
obtained with droperidol. There has been very little study of the newer
antipsychotic medications (risperidone, olanzapine, and quetiapine) in the
treatment of delirium.
To identify the type of evidence supporting the major recommendations in the
full-text practice guide, each is keyed to one or more references and each
reference is followed by a letter code in brackets that indicates the nature of
the supporting evidence. Minor recommendations not keyed to references may be
assumed to be based on expert opinion.
The bracketed letter following each reference indicates the nature of the
supporting evidence, as follows:
[A] Randomized controlled clinical trial
[B] Nonrandomized case-control study
[C] Nonrandomized cohort study
[D] Clinical report with nonrandomized historical comparison groups
[E] Case report or series
[F] Expert consensus
[G] Subject review subsuming multiple categories A-E