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Table 4 Synthesis of recommendations for guidelines reporting on anxiety, depression, and post-traumatic stress disorder in delirium

From: Clinical practice guideline recommendations for diagnosis and management of anxiety and depression in hospitalized adults with delirium: a systematic review

Author

Guideline name

Anxiety

Depression

Post-traumatic stress disorder

Andersen et al.

Screening, Assessment, and Care of Anxiety and Depressive Symptoms in Adults with Cancer: An American Society of Clinical Oncology Guideline Adaptation

•Treat reversible medical causes of symptoms

•Assess and screen based on specific risk factors using validated tools a

•Recommend treatment pathways b based on the severity of symptoms

•Follow-up and assess compliance on a biweekly or monthly basis until remission

 

BC Guidelines and Protocols Advisory Committee

Palliative Care for the Patient with Incurable Cancer or Advanced Disease Part 2: Pain and Symptom Management

 

•Treat reversible medical causes of symptoms first

•Differentiate mental symptoms from normal grieving process

•Select an antidepressant for pharmacological intervention with the least amount of drug interactions c

 

Jacobi et al.

Clinical Practice Guidelines for the Sustained Use of Sedatives and Analgesics in the Critically Ill Adult

•Use pharmacological sedation for agitation only after treating reversible medical causes and providing analgesia

 

Refer to anxiety recommendations

McNeill et al.

Delirium, Dementia, and Depression in Older Adults: Assessment and Care, Second Edition

 

•Assess and screen using validated tools d, risk factors e, and collaboration with family caregivers

•Assess patients with suspected or present depression for risk of suicide and further refer for an in-depth assessment by a mental health specialist

•Develop an individualized treatment plan using a collaborative approach and consider the effects of co-morbid dementia

•Use evidence-based pharmacological antidepressants and non-pharmacological f interventions, educate patient and family caregivers about depression and management options g

•Monitor depression for changes and document effectiveness of treatment

 

NICE rapid guideline development group

COVID-19 Rapid Guideline: Managing Symptoms (including at the end of life) in the Community

•Use non-pharmacological interventions to address medical and environmental causes of anxiety

•Use a benzodiazepine h for pharmacological intervention

  

Trzepacz et al.

Practice Guideline for the Treatment of Patients with Delirium

•Prioritize treating delirium first over other comorbid psychiatric disorders

•Minimize or do not begin pharmacological treatments (antidepressant or anxiolytic) for comorbid psychiatric conditions until delirium has resolved to limit the risk of aggravation

 

Virani et al.

Caregiving Strategies for Older Adults with Delirium, Dementia and Depression

 

•Maintain a high level of attention for early recognition and treatment of depression

•Use standardized tools i to identify depression and pharmacological risk factors j

•Use non-pharmacological k and pharmacological l interventions

•Facilitate patient-family communication

•Monitor depression for changes based on stage of recovery

 
  1. Abbreviations: BC British Colombia, COVID-19 Coronavirus disease of 2019, NICE National Institute for Clinical Excellence
  2. aE.g., Generalized Anxiety Disorder 7-item (GAD-7), Patient Health Questionnaire 9 (PHQ-9) (See guideline Table 2, pg. 1612 for additional detail)
  3. bE.g., None/mild symptomatology offers supportive care services, moderate symptomatology offers low intensity psychological or pharmacological interventions, severe symptomatology offers high intensity psychological or pharmacological interventions (See guideline Figure 1B, pg. 1610 [depression] and Figure 2B, pg. 1615 [anxiety] for additional detail)
  4. cE.g., Selective Serotonin Reuptake Inhibitor, Selective Serotonin Norepinephrine Reuptake Inhibitor, Tricyclic Antidepressant (See guideline Additional file 3: Appendix A, pg. 1-2 for additional detail)
  5. dE.g., Geriatric Depression Scale, Patient Health Questionnaire-9 (PHQ-9), Distress Thermometer (See guideline Additional file 3: Appendix H, pg. 141–142 for additional detail)
  6. eE.g., Cognitive decline or dementia, social isolation, personal or family history of depression or mood disorder (See guideline Table 4, pg. 71 for additional detail)
  7. fE.g., psychotherapy, exercise, electroconvulsive therapy (See guideline Table 5, pg. 76-77 for additional detail)
  8. gKey topics include self-management, lifestyle modification, therapeutic interventions, safety, and follow-up care (See guideline Table 6, pg. 78 for additional detail)
  9. hE.g., lorazepam, midazolam, haloperidol (See guideline Table 6, pg. 18-19 for additional detail and dosage scheme)
  10. IE.g., Diagnostic criteria from the Diagnostic and Statistical Manual (DSM) IV-R, Sig:E Caps, Cornell Scale for depression (See guideline Additional file 3: Appendix K, pg. 141-144 for additional detail)
  11. jE.g., Antihypertensives, Antimicrobials, Analgesics (See guideline Additional file 3: Appendix U, pg. 176 for additional detail)
  12. kE.g., Education for clients, environment and light therapy, Aromatherapy (See guideline pg. 72 for additional detail)
  13. lE.g., Selective serotonin reuptake inhibitors (SSRI), tricyclic antidepressants are not recommended (See guideline pg. 73-74 for additional detail)
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Systematic Reviews

ISSN: 2046-4053