Delirium is a common neuropsychiatric condition but remains frequently underrecognized across medical settings. The American Psychiatric Association (APA) just released a new Practice Guideline for the Prevention and Treatment of Delirium for the first time since 1999. The new Guideline offers structured, evidence-based recommendations to improve identification, prevention, and management of delirium across care settings. It also includes structured guidance for transitions of care with explicit calls for medication reconciliation, delirium follow-up, and psychoeducation for patients and caregivers.

The updated guideline addresses assessment, nonpharmacologic and pharmacologic interventions, and transitions of care. Key changes include a stronger emphasis on prevention, with APA now recommending multicomponent nonpharmacologic strategies for patients at risk (1B), regular structured screening using validated tools (1C), and minimizing use of medications with deliriogenic potential. Serotonin-dopamine antagonists and partial agonists (SDA-PAs) (aka “antipsychotics”) should only be used when neuropsychiatric symptoms are severe, have not responded to de-escalation, and pose a risk of harm (1C). Routine use of SDA-PAs or benzodiazepines for prevention or hastening resolution of delirium is not recommended. In mechanically ventilated patients, dexmedetomidine is suggested over other sedating agents (2B/2C), while melatonin and ramelteon are not recommended (2C).

Clinicians across disciplines should be aware of these updates, particularly the shift toward proactive, multicomponent prevention. Additional implementation resources, such as training slides, patient/family guides, and vignettes, will be available through APA Publishing to support real-world application. .

Reference:
Updated comprehensive Guideline for the Prevention and Treatment of Delirium. American Psychiatric Association. September 2, 2025. Accessed September 3, 2025. View Here