title: The use of environmental strategies and psychotropic medication in the management of delirium.
abstract: BACKGROUND
  This paper examines the pattern and frequency of implementation of environmental strategies and the use of psychotropic medication in the management of patients with delirium in an acute hospital setting.
  
  
  METHODS
  The study involved 46 consecutive referrals to a consultation psychiatry service each of whom met ICD-10 criteria for delirium. Patients were subdivided into hyperactive, hypoactive and mixed subtypes of delirium and assessed regarding severity of delirium, the use of psychotropic medication prior to consultation and the implementation of environmental measures in their management.
  
  
  RESULTS
  Mean age was 60.1 years. Thirty per cent of patients were of the hyperactive subtype, 24% hypoactive and 46% mixed. Psychotropic medication was given to 56.5% prior to consultation and this is significantly associated with severity of delirium and in particular, with hyperactive delirium subtype. Of eight environmental strategies only four were instituted in over 50% of the patients prior to consultation. The application of these strategies was associated with overall severity of delirium, agitation, mood lability and sleep-wake cycle disturbance. It was not significantly associated with severity of disorientation or with disturbed perception/thinking.
  
  
  CONCLUSIONS
  Simple environmental strategies such as limiting changes in staff, minimising noise levels and involving relatives in re-orientation are frequently overlooked in the management of patients with delirium. Our study suggests that the implementation of environmental strategies occurs primarily in responses to behavioural challenges rather than to limit the core features of delirium.
authors.affiliation: Department of Adult Psychiatry, Mater Misericordiae Hospital, Dublin.
authors.forename: D J
authors.initials: DJ
authors.lastname: Meagher
authors.forename: D
authors.initials: D
authors.lastname: O'Hanlon
authors.forename: E
authors.initials: E
authors.lastname: O'Mahony
authors.forename: P R
authors.initials: PR
authors.lastname: Casey
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003131:Combined Modality Therapy; D003693:Delirium / Q000175:diagnosis / Q000523:psychology / Q000628:therapy*; D005260:Female; D006760:Hospitalization; D006769:Hospitals, General; D006801:Humans; D007494:Ireland; D008297:Male; D008875:Middle Aged; D010348:Patient Care Team; D011446:Prospective Studies; D011619:Psychotropic Drugs / Q000009:adverse effects / Q000627:therapeutic use*; D012931:Social Environment; D012960:Socioenvironmental Therapy
chemical_list: D011619:Psychotropic Drugs