APA Publishes Updated Comprehensive Practice Guideline for the Prevention and Treatment of Delirium

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The American Psychiatric Association (APA) has published the updated comprehensive Practice Guideline for the Prevention and Treatment of Delirium. This new guideline is designed to assist any clinician who may encounter patients with delirium and includes evidence-based recommendations to improve its detection, prevention, and treatment.¹

Delirium is expected to affect about 23% of adults in inpatient medical units, 31% of adults in intensive care units (ICUs), and 75% of patients who are mechanically ventilated in ICUs. Despite this prevalence, delirium is frequently not recognized, which can lead to longer hospital stays, greater risk of complications, increased strain on patients and caregivers, and significant additional health care costs.

The goal of the guideline is to prevent at-risk individuals from developing delirium and to improve the quality of care and treatment outcomes for those who have it. The practice guideline includes 12 clinical recommendations and 3 suggestions, depending on the level of scientific evidence.

The guideline was developed by the APA Practice Guideline Writing Group, which is chaired by Catherine Crone, MD. The Writing Group conducted an extensive review of research evidence and used a process consistent with the recommendations of the Institute of Medicine (2011) and the Council of Medical Specialty Societies (2017) in developing the guideline. A detailed description of the process and research evidence are included in the guideline and accompanying appendices. Members of the multidisciplinary writing group included experts from psychiatry, internal medicine, family medicine, and critical care nursing.

“All too often, clinical guidelines come across as 2-dimensional documents that are intellectual exercises rather than what they truly are: carefully considered, evidence-based guides that can be applied to direct patient care, quality improvement efforts, as well as the education of colleagues and trainees in psychiatry and other disciplines, with the end result being improvement in patient care,” said Crone.

Mark A. Oldham, MD, an associate professor of psychiatry at the University of Rochester Medical Center and the immediate past presidents of the American Delirium Society, recently shared with Psychiatric Times that prevention is a key differentiator from the last guidelines, which were published in 1999. Most guidelines are considered out of date after 5 years and the lack of newer treatments may have delayed these revisions.² Watch the exclusive interview with Oldham here.

The full "Practice Guideline for the Prevention and Treatment of Delirium," executive summary and appendices are available free online and as a printed copy for purchase from APA Publishing. The APA is also developing related resources to facilitate understanding of the guideline and its implementation, including training slides, clinician guide, patient/family guide, webinar and case vignettes. All materials will be available to practitioners and the public.

References

1. American Psychiatric Association publishes updated comprehensive Guideline for the Prevention and Treatment of Delirium. American Psychiatric Association. September 2, 2025. Accessed September 2, 2025. https://www.psychiatry.org/News-room/News-Releases/APA-Published-Updated-Guideline-for-Delirium

2. Oldham MA, Miller JJ. New delirium guidelines discussed at APA Annual Meeting. Psychiatric Times. May 20, 2025. https://www.psychiatrictimes.com/view/new-delirium-guidelines-discussed-at-apa-annual-meeting