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Throughout the formulation of a treatment plan and the subsequent course of treatment, the following principles of psychiatric management should be kept in mind:

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1. Coordinate with other physicians.

  • Treatment of patients with delirium frequently requires joint and coordinated management among psychiatrists and other general medical and specialty physicians.

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2. Identify etiological factors and correct them.

  • Review information from the patient's medical and psychiatric history, family members, and other individuals close to the patient.

  • Conduct indicated laboratory and radiological investigations to determine the underlying cause or causes of the patient's delirium. The choice of specific tests will be guided by the results of clinical evaluations and may include those outlined in Table 1.

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Table Reference Number
TABLE 1. Assessment of Patients With Delirium
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3. Initiate acute interventions.

  • Patients with delirium may have general medical conditions that require urgent therapeutic intervention, even before an etiology for the delirium is identified.

  • Increased observation and monitoring of the patient's general medical condition are often necessary, including frequent monitoring of vital signs, fluid intake and output, and oxygenation level.

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4. Provide other disorder-specific treatments.

  • Reversible causes of delirium that are identified should be promptly treated as noted in Table 2.

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Table Reference Number
TABLE 2. Examples of Reversible Causes of Delirium and Their Treatments
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5. Monitor and ensure safety.

  • Monitor patients with delirium for their potential to harm themselves or others. Harmful behaviors are often inadvertent or are responses to hallucinations or delusions.

  • Take appropriate measures to prevent harm to self or others. Whenever possible, the least restrictive but effective measures should be employed.

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6. Assess and monitor psychiatric status.

  • Regularly monitor symptoms and behaviors, as they can fluctuate rapidly.

  • Adjust treatment strategies accordingly.

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7. Establish and maintain alliances with patient and family.

  • Establish a supportive therapeutic stance with patients.

  • Establish strong alliances with the patient's family members, multiple clinicians, and caregivers.

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8. Educate regarding the illness.

  • Education regarding the current delirium, its etiology, and its course should be provided to patients and tailored to their ability to understand their condition.

  • Education regarding delirium may also be extremely beneficial to patients' families, nursing staff, and other medical clinicians.

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9. Provide postdelirium management.

  • Following recovery, reiterate explanations to patient and family about delirium, its etiology, and its course in order to prevent recurrences.

  • Provide education regarding the apparent cause or causes of and risk factors for delirium.

  • Employ supportive interventions for patients experiencing distressing postdelirium symptoms.

Table Reference Number
TABLE 1. Assessment of Patients With Delirium
Table Reference Number
TABLE 2. Examples of Reversible Causes of Delirium and Their Treatments

References

NOTE:
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