Key messages

• Narcotics and drugs with anticholinergic properties account for a large proportion of drug-induced confusional states. The first step in treating drug-induced delirium is to stop the offending drug and to find an alternative compound without similar adverse effects.

• The successful treatment of withdrawal-induced agitation and confusion requires the replacement of the same substance or a cross-reacting compound with less adverse effects and a better pharmacokinetic profile.

• When a specific cause of agitation and confusion cannot be identified or corrected, it is still important to stabilize the patient and to ensure his or her safety.

• Haloperidol, a high-potency neuroleptic of the butyrophenone class that blocks postsynaptic D 2 dopamine receptors, has an extensive record of safety and efficacy in critically ill patients and is most often used to treat the agitated delirious patient.

• Agitation due to panic attacks, generalized anxiety, or fear of being in the ICU should be treated primarily with a benzodiazepine.

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