Practice Guideline for the Treatment of Patients with Delirium. Also includes Treating Delirium: A Quick Reference for Psychiatrists. By the American Psychiatric Association. Washington, DC: American Psychiatric Association. 1999. 64 pp. $ 22.50 ISBN 0-89042-313-X

This is the tenth in a series of practice guidelines published by the American Psychiatric Association and has been produced by consensus forming among experts in the field of delirium. I think the guidelines are excellent, providing a useable and welcome review of the management of delirium, as well as showing the direction developments in the management of this condition are likely to take us. They are well written, as well as up to date with the latest trends in our understanding of the outcome of delirium.

The guidelines discuss and outline the causes, investigation and management of delirium from the medical, psychiatric and environmental perspective. They are backed up by a quality review of the evidence base in the literature. The guidelines cover almost all the key areas of importance in delirium and give advice on the choice of therapeutic agents and other interventions. My only disappointment is that they do not really mention the differentiation of delirium from dementia, which is an important problem in the management of both conditions (Macdonald & Treloar, 1996). Topics even included a discussion of electroconvulsive therapy and delirium (only possibly indicated in the neuroleptic malignant syndrome). In addition, as is so often the case the guidelines highlight some of the differences between US and European psychiatry. Here is discussion of the use of restraints; interestingly, they are considered particularly safe for elderly people because of the lack of drug interactions, but it is admitted that fractures are a special risk in this group. More importantly, even though a solid evidence base for newer drugs is awaited, the guidelines show that we are now moving towards the use of physostigmine and other cholinesterase inhibitors in the acute management of delirium. In many ways the management of delirium has always been one of passively containing the problem until it either goes away or progresses to dementia. Now, we can see the beginnings of the active management of delirium with, hopefully, improved outcomes as a result.

I think this work is the best review I have seen of delirium and would recommend it for all libraries that postgraduate psychiatrists and physicians use. It would be a very useful standard resource for old age psychiatrists as well. As ever, we will need to help our medical colleagues find out more about delirium, and this book may well be helpful in this respect.

Finally, there is a useful Patient and Family Guide for Delirium included. I know of many families who would like to have such a document while they watch their relatives struggle through a delirious process.