Delirium Prevention — MRCPsych Paper B MCQ

Correct answer: E — Within 24 hours, assess contributing factors and provide a tailored multidisciplinary package addressing cognition, hydration, constipation, hypoxia, infection, mobility, pain, medicines, nutrition, sensory impairment and sleep.

Explanation lettering: E = shown as A · C = shown as B · A = shown as C · B = shown as E

B is correct. NICE recommends assessing people at risk within 24 hours of admission and providing a tailored, multicomponent intervention delivered by a multidisciplinary team competent in delirium prevention. The package addresses modifiable factors including disorientation, dehydration or constipation, hypoxia, infection, immobility, pain, medication burden, poor nutrition, sensory impairment and disturbed sleep. Routine prophylactic haloperidol or benzodiazepines is not the recommended prevention strategy; benzodiazepines may themselves contribute to delirium outside specific indications such as alcohol withdrawal. Melatonin alone does not constitute the recommended package. Daily observation and assessment help detect delirium, but screening alone is not preventive and measures should be instituted while the patient is at risk rather than delayed until delirium develops.

Reference: National Institute for Health and Care Excellence. Delirium: prevention, diagnosis and management in hospital and long-term care (CG103), section 1.4, recommendations 1.4.1–1.4.13. Published 2010; updated 2023. https://www.nice.org.uk/guidance/cg103/chapter/Recommendations