Delirium & Agitation
Background: Consultation-Liaison (C-L) clinicians are asked to see patients in settings in which comorbidities and complex pharmacological regimens are the rule rather than the exception. While psychiatrists and other behavioral health clinicians are experts at diagnosing and managing many forms of delirium, there is a lack of consensus about the best pharmacological interventions to treat delirium. Furthermore, there is no FDA-approved medication for the treatment of delirium. As a result, there is increasing recognition of the importance of de-prescribing and minimizing commonly known delirium offenders. Knowledge of the degree to which commonly prescribed non-psychiatric medications contribute to delirium is critical for the C-L clinician. With such knowledge, the C-L clinician could more expertly recommend medication algorithms that are least deliriogenic. Unfortunately, a carefully crafted strategy to do this is not well codified in the field. The goal of this presentation is to attempt to remedy this gap by discussing the existing literature surrounding five major classes of medications commonly used in inpatient settings, and their risk of contributing to delirium. By having a working hierarchy of "deliriogenicity" for each of these five major classes of medications, the C-L clinician will feel more empowered to discuss the risks of these medications with non-psychiatric colleagues, and even propose alternative, less deliriogenic regimens. By extension, this expert knowledge will extend the value of the C-L clinician in the hospital setting and help to reduce the burden of delirium in patients suffering from complex medical conditions.
Methods: This general session will leverage case reports, case series, and reviews related to five major classes of medications and their risk of contributing to delirium. In addition to establishing delirium risk hierarchies for each class, little known contributors to delirium and major offenders will be highlighted.
Dr. Caitlin Adams will discuss the literature on analgesics and muscle relaxants and their risk of causing delirium (15 minutes).
Dr. Benjamin Cooley will discuss the available literature surrounding antibiotics and risk for delirium (15 minutes).
Dr. Shariff Tanious will discuss the state of the literature of choice of sedative in the ICU with respect to risk of delirium (15 minutes).
Dr. Nate Sowa will review the commonly used immunosuppressants and discuss which agents are most likely to contribute to delirium (15 minutes).
Dr. Emily Holmes will review the state of the literature surrounding major classes of gastrointestinal medications and risk of delirium (15 minutes).
Conclusions: After attending this session attendees will have a better working knowledge of how medications in five major classes contribute to or perpetuate delirium in hospitalized patients with complex pharmacological regimens and comorbidities.