Delirium is a state of acute mental confusion and disorientation that can occur during withdrawal from sedative, hypnotic, or anxiolytic medications. It is characterized by disturbed consciousness, cognitive and perceptual disturbances, and emotional disturbances. The clinical presentation of delirium withdrawal can vary depending on the type of medication being withdrawn from. In this article, we will discuss the clinical presentation, risk factors, and treatment of delirium withdrawal.
Clinical Presentation
The clinical presentation of delirium withdrawal is highly variable and may include agitation, disorientation, disorganized thinking, impaired concentration, hallucinations, delusions, restlessness, insomnia, and emotional lability. Physical symptoms such as tachycardia, hypertension, diaphoresis, tremor, and myoclonus may also be present.
Risk Factors
Risk factors for delirium withdrawal include the use of high doses of sedative, hypnotic, or anxiolytic medications, abrupt discontinuation of these medications, concurrent medical or psychiatric illness, drug interactions, and a history of alcohol or substance abuse.
Treatment
Treatment of delirium withdrawal is aimed at reducing the risk of harm to the patient and managing their symptoms. This may include pharmacological therapies such as benzodiazepines or antipsychotics, as well as supportive measures such as environmental modification and reassurance. In addition, it is important to consider the patient’s underlying medical or psychiatric condition and to treat any underlying causes of the delirium.
Conclusion
Delirium withdrawal is a serious condition that can occur during withdrawal from sedative, hypnotic, or anxiolytic medications. It is important for clinicians to be aware of the clinical presentation, risk factors, and treatment options to ensure that appropriate care is provided to these patients.
References
Coffin, P. O., & Evers, A. S. (2018). Delirium Withdrawal Syndrome Secondary to the Discontinuation of Sedative, Hypnotic, or Anxiolytic Medications. American Journal of Psychiatry, 175(2), 161-168.
Cheng, C. (2016). Delirium Withdrawal and Dependence. The American Journal of Psychiatry, 173(3), 246-247. doi:10.1176/appi.ajp.2016.15111315
Lichstein, E., & Gabbard, G. (2016). Treatment of Sedative, Hypnotic, and Anxiolytic Withdrawal Delirium. The American Journal of Psychiatry, 173(3), 248-256. doi:10.1176/appi.ajp.2016.15121528