By The Royal Australian College of General Practitioners
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Additional resources for Guidelines for Preventive Activities in General Practice (Res Book)
Qxd 02 31/3/06 12:50 PM Page 24 Common clinical conditions Delirium Delirium (acute brain syndrome, acute confusional state or acute organic psychosis) is an acute or subacute deterioration in mental functioning that occurs commonly in the older population, particularly in hospitals and RACFs. The cause is usually multifactorial and reversible, and may involve infection, metabolic disturbance, hypoxia, and medication toxicity or withdrawal. In hospital, delirium occurs in 30% of older patients and predicts poorer outcome and greater length of stay.
124 Medication for the management of distressing BPSD may be considered in addition to nonmedication interventions. 126 Antipsychotic agents may be required to manage distressing psychotic symptoms, aggression and behavioural disturbance. 128 Respiridone, an atypical neuroleptic agent, is effective for reducing psychotic features and aggression. 134 Behavioural disturbances may be short term, therefore the need for medication should be reviewed within 6 months and the dose diminished and discontinued where possible.
Depression is common in the early stages. 111 The model divides people with BPSD into seven tiers in ascending order of symptom severity and decreasing levels of prevalence. Recommended treatment is cumulative through the tiers, with increasing interventions as symptoms become more serious. • Tier 1: For no dementia, management is universal prevention, although specific strategies to prevent dementia remain unproven • Tier 2: For dementia with no BPSD (40% prevalence), management is by selected prevention through preventive or delaying interventions (not widely researched) • Tier 3: For dementia with mild BPSD (prevalence 30%), eg.