Delirium should be considered

EDITOR—The account of an assault on a nurse in the course of her work is distressing, and familiar to NHS staff.1 The clinical picture is of an agitated patient trying to leave the ward at night, within a day of admission with diabetic ketoacidosis. He was deemed unfit to be discharged, to the extent that the police were called to ensure his return to medical care. There may have been several causes for the violent outburst, for which the patient may rightly be held culpable. I was concerned, however, that all three commentaries failed to raise the possibility of delirium being relevant to the outburst.2

I encourage staff to press criminal charges when they are assaulted at work, as they would when out on the street or in their homes. But appropriate medical advice also needs to be available to police and staff if a patient is not legally responsible for his or her actions due to …