Benzodiazepines for Withdrawal Delirium — SCE Palliative Medicine MCQ

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ModeratePsychological & PsychiatricBenzodiazepines for Withdrawal DeliriumSCE Palliative Medicine

A 50‑year‑old man with advanced sarcoma on high‑dose opioids develops hyperactive delirium with agitation and paranoia. His haloperidol dose has been escalated to 10 mg/24 hr without adequate effect. Benzodiazepines are being considered. In which specific type of delirium are benzodiazepines the treatment of choice rather than antipsychotics?

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Correct answer: B — Alcohol or benzodiazepine withdrawal delirium

Explanation lettering: E = shown as C · C = shown as D · D = shown as E

Option B is correct. Both NICE CG100 and updated UK alcohol treatment guidelines state that in delirium tremens (a form of withdrawal delirium), benzodiazepines (e.g., oral or parenteral lorazepam) are the first‑line agents, and antipsychotics should not be used alone. This reflects the pathophysiology (GABA deficiency, seizure risk) and pharmacological rationale. Options A, C, D are incorrect—antipsychotics remain first‑line for most other delirium types. Option E is overly broad and incorrect. Apply this conclusion only to the clinical circumstances stated, with appropriate specialist review, contraindication checks, shared decision-making and follow-up. Reassess if the physiology, treatment response or competing risk changes. The competing options would require a different haemodynamic profile, diagnosis, procedural indication or risk balance from the one described here.

Reference: GOV.UK Clinical guidelines for alcohol treatment (Alcohol care in acute hospitals), updated April 2026; NICE CG100 (Alcohol‑use disorders…), amended 2017: https://bnf.nice.org.uk/