Delirium: Prevention

To prevent delirium, attention must be paid to reducing individual risk factors. Reinforce delirium risk:

Behavioral risk factors

  • Diet
    • Malnutrition
  • Consumption of stimulants
    • Alcohol (here: alcohol abuse)
  • Drug use
    • Amphetamines and metamphetamines (“crystal meth”).
    • Ecstasy (also XTC and others) – collective name for a variety of phenylethylamines.
    • GHB (4-hydroxybutanoic acid, obsolete also gamma-hydroxybutanoic acid or gamma-hydroxybutyric acid; “liquid ecstasy“).
    • Cocaine
    • LSD (lysergic acid diethylamide/lysergide)
    • Opiates – powerful painkillers such as morphine.
    • PCP (phenylcyclohexylpiperidine, abbreviation of: phencyclidine; “angel dust”).

Disease-related risk factors.

Endocrine, nutritional and metabolic diseases (E00-E90).

  • Dehydration (lack of fluids).
  • Electrolyte disorders (blood salts)
  • Hyponatremia (sodium deficiency), diuretic-induced (due touse of drainage drugs).
  • Malnutrition

Medications that promote the development of delirious symptoms (modified from).

  • ACE inhibitors
  • Alpha blocker
  • Analgesics:
    • Acetylsalicylic acid (delirogenic only in high doses).
    • Nonsteroidal anti-inflammatory drugs (NSAIDs) can cause delirium
    • Opiates (high-risk substances when starting and also when discontinuing).
  • Antiarrhythmics
  • Antibiotics
  • Anticholinergics
  • Antidepressants:
  • Antidiabetic agents, oral – which induce hypoglycemia.
  • Antiepileptic drugs, including phenytoin.
  • Antihypertensives (antihypertensive drugs) – alpha-receptor blockers (CNS attenuation can be enhanced by alcohol, antipsychotics, antihistamines, benzodiazepines and opiates).
  • Anticonvulsants (antiepileptic drugs) – adverse drug reaction usually due to overdose; Cave! Hyponatremia under carbamazepine and oxcarbazepine.
  • Antipsychotics (neuroleptics) – preparations with anticholinergic potency (e.g., clozapine and olanzapine) are more delirogenic
  • Antivertiginosa
  • Beta blockers
  • Benzodiazepines (3-fold risk of delirium) – withdrawal may cause delirium
  • Calcium antagonists
  • Narcotics (BtM)
  • Digitalesglycosides, e.g., digitoxin, digoxin.
  • Diuretics (especially thiazides).
  • Hormones
    • Corticosteroids, systemic
    • Steroids, systemic (delirogenic risk is dose-dependent).
  • Ketamine (narcotic)
  • Lithium
  • MAO inhibitors
  • Neuroleptics (D2 antagonists and serotonin–dopamine antagonists) (4.5-fold risk of delirium)
  • Nonsteroidal anti-inflammatory drugs (NSAIDs).
  • Nitrates and other vasodilators.
  • Lidocaine
  • Opiates
  • Opioids (2.5 times the risk of delirium)
  • Parasympatholytics
  • Parkinson’s drugs:
    • Amantadine and dopamine agonists (e.g., bromocryptine) (higher risk).
    • Cathechol-O-methyltransferase (COMT) inhibitors (low risk).
    • Levodopa (lowest delirogenic potency).
  • Herbal agents, unspecified.
  • Psychoactive drugs (including antipsychotics, antidepressants, tranquilizers).
  • Sedating H1 antihistamines (also known as antiemetics).
  • Theophylline

Other risk factors

  • Immobility
  • Polypharmacy (> 6 prescribed medications).
  • Reduced sensory perceptions such as impaired vision, hearing, etc.
  • Poor general health

Increase the risk of delirium in the hospital:

  • Acute metabolic derailment
  • Dehydration
  • Urinary bladder catheterization
  • Infections
  • Insomnia (sleep disturbance), unspecified
  • Cognitive deficits
  • Physical disability (immobility), unspecified
  • Artificial respiration
  • Malnutrition (malnutrition)
  • Mental and physical stress (e.g., surgery).
  • Senile dementia of the Alzheimer type
  • Sensory disturbances (visual impairments; hearing impairments).
  • Hours of waiting for surgery
  • Therapy with at least three new drugs
  • Insufficient / exaggerated pain therapy

Prevention factors (protective factors)

  • See also under “Fall propensity/prevention.”
  • Elderly patients must be protected from cognitive overload (e.g., earplugs and night mask in ICU)
  • Avoid unnecessary hospitalization and polypragmasia (meaningless and conceptless diagnosis and treatment with numerous drugs and remedies and other therapeutic measures).