I would like to address Dr. Mitchell Levy’s comments regarding the staggering percentage of delirium cases seen in consultation-liaison settings and physicians’ astonishing lack of understanding of the condition (10 delirium myths debunked,” Pearls, Current Psychiatry, October 2006) salient aspects of delirium diagnosis and management that could be useful for a range of medical providers. I agree that few comprehensive teaching resources exist for nonspecialists, and methods of addressing delirium often are late, nonstandardized, and desultory.
Dr. Pistone stresses the existing gaps in resources for comprehensive and evidence-based management of delirium. Collaborations such as the one he suggests may help update our treatment guidelines at the national level. My group is developing a hospital-wide protocol for identifying at-risk patients and directing intervention. I hope that these and other efforts will help physicians address a problem that may occur more frequently as patients age and medical procedures increase in intensity and severity.
Mitchell Levy, MD
Assistant professor in psychiatry
University of Washington, Seattle