| Index of suspicion |
| Low threshold for cognitive assessment/using screening tools, particularly where multiple predisposing and/or precipitating factors are present |
| |
| Identification and diagnosis |
| Using, for example, DSM IV criteria or a validated tool, eg, Confusion Assessment Method |
| |
| Evaluate reversibility and treat reversible causes |
| Review all medication. Assess, examine and investigate for reversible causes to a level appropriate for the patient |
| |
| Pharmacological and non‐pharmacological management |
| Make optimal use of non‐pharmacological strategies and make the environment safe and comfortable. Where pharmacological agents required aim to use one drug at the lowest possible dose |
| Non‐pharmacological |
Pharmacological |
| Appropriate lighting for the time of day |
Predominantly neuroleptic effects: |
| Clocks and calendars to improve orientation |
Haloperidol 0.5–1 mg initially titrated to effect (use first line*) |
| Hearing/visual aids to reduce sensory impairment |
Olanzapine 2.5–5 mg daily |
| Encourage mobility and engagement in activities with other people |
Risperidone 0.5 mg twice daily |
| Avoid physical restraint, eg, cot sides |
Quietiapine 25 mg twice daily |
| Continuity of care from nursing staff |
Predominantly sedative effects: |
| Presence of family members, familiar objects, pictures of home and family |
Lorazepam 0.5 mg‐1 mg 4 hourly |
| Reduced abnormal distractions, eg, noise |
Midazolam 2.5 mg subcutaneously |
| Encourage adequate fluid intake to prevent dehydration and constipation |
Levopromazine 12.5 mg–25 mg |
| *except alcohol/drug withdrawal or Lewy body dementia where benzodiazepines are preferable |
| |
| Involve family and carers |
| Explain, discuss and support. Involve in non‐pharmacological management. Obtain background and additional history, eg, pre‐admission cognitive status, drug and alcohol use |
| |
| Review and reassess frequently |
