The American Psychiatric Association (APA) recently released a draft copy of their new 2025 clinical practice guidelines for Prevention and Treatment of Delirium. The draft is currently undergoing copyediting, and a formal publication will follow soon. In the meantime, here are the highlights and key recommendations from this new APA delirium guideline!
Assessment and Treatment Planning
- APA recommends (1C) that patients with delirium or who are at risk for delirium undergo regular structured assessments for the presence or persistence of delirium using valid and reliable measures.
- APA recommends (1C) that a patient's baseline neurocognitive status be determined to permit accurate interpretation of delirium assessments.
- APA recommends (1C) that patients with delirium or who are at risk for delirium undergo a detailed review of possible predisposing or contributing factors.
- APA recommends (1C) that a detailed medication review be conducted in patients with delirium or who are at risk for delirium, especially those with pre-existing cognitive impairment.
- APA recommends (1C) that physical restraints not be used in patients with delirium, except in situations where injury to self or others is imminent and only:
after review of factors that can contribute to racial/ethnic and other biases in decisions about restraint;- with frequent monitoring; and
- with repeated reassessment of the continued risks and benefits of restraint use as compared with less restrictive interventions.
- APA recommends (1C) that patients with delirium have a documented, comprehensive, and person-centered treatment plan.
Nonpharmacological Interventions
- APA recommends (1B) that patients with delirium or who are at risk for delirium receive multicomponent nonpharmacological interventions to manage and prevent delirium.
Pharmacological Interventions
- APA recommends (1C) that medications, including antipsychotic agents, be used to address neuropsychiatric disturbances of delirium only when all the following criteria are met:
- verbal and non-verbal de-escalation strategies have been ineffective;
- contributing factors have been assessed and, insofar as possible, addressed; and
- the disturbances cause the patient significant distress and/or present a risk of physical harm to the patient or others.
- APA recommends (1C) that antipsychotic agents not be used to prevent delirium or hasten its resolution.
- APA recommends (1C) that benzodiazepines not be used in patients with delirium or who are at risk for delirium, including those with pre-existing cognitive impairment, unless there is a specific indication for their use.
- APA suggests that (2B) dexmedetomidine be used rather than other sedating agents to prevent delirium in patients who are undergoing major surgery or receiving mechanical ventilation in a critical care setting.
- APA suggests (2C) that when patients with delirium are sedated for mechanical ventilation in a critical care setting, dexmedetomidine be used rather than other sedating agents.
- APA suggests (2C) that melatonin and ramelteon not be used to prevent or treat delirium.
Transitions of Care
- APA recommends (1C) that, in patients with delirium or who are at risk for delirium, a detailed medication review, medication reconciliation, and reassessment of the indications for medications, including psychotropic medications, be conducted at transitions of care within the hospital.
- APA recommends (1C) that, when patients with delirium are transferred to another setting of care, plans for follow-up include:
- continued assessments for persistence of delirium;
- detailed medication review, medication reconciliation, and reassessment of the indications for medications, including psychotropic medications;
- assessment of consequences of delirium (e.g., post-traumatic symptoms, cognitive impairment); and
- psychoeducation about delirium for patients and their care partners.
There you have it - a spotlight on the new delirium guidelines from the American Psychiatric Association. Keep an eye on our Guidelines Library for the formal publication of the Guideline Pocket Guide, summary, and patient summary / patient guide. We expect these to be available sometime in Q2. In the meantime, you can also check out the other APA Guidelines here.
See you next time!