Delirium: Difference between revisions
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{{Infobox medical condition | |||
| name = Delirium | |||
| image = [[File:DELIRIUM_Still_7.jpg|alt=Delirium]] | |||
| caption = A depiction of delirium | |||
| field = [[Psychiatry]], [[Neurology]] | |||
| symptoms = [[Confusion]], [[disorientation]], [[hallucinations]], [[agitation]], [[inattention]] | |||
| onset = Rapid | |||
| duration = Hours to days | |||
| causes = [[Infection]], [[substance intoxication]], [[substance withdrawal]], [[metabolic disorders]], [[trauma]], [[surgery]] | |||
| risks = [[Elderly]], [[hospitalization]], [[dementia]], [[polypharmacy]] | |||
| diagnosis = [[Clinical assessment]], [[Confusion Assessment Method]] | |||
| differential = [[Dementia]], [[psychosis]], [[depression]] | |||
| treatment = Address underlying cause, [[antipsychotics]], [[supportive care]] | |||
| prognosis = Variable, depends on underlying cause | |||
| frequency = Common in hospitalized patients, especially the elderly | |||
}} | |||
'''Delirium''' is an acute and usually reversible disturbance in mental function, characterized by a fluctuating course, inattention, and either altered level of consciousness or cognitive dysfunction. It represents a serious and common complication in hospitalized patients, particularly the elderly, and is associated with increased mortality, length of hospital stay, and risk of long-term cognitive impairment. | '''Delirium''' is an acute and usually reversible disturbance in mental function, characterized by a fluctuating course, inattention, and either altered level of consciousness or cognitive dysfunction. It represents a serious and common complication in hospitalized patients, particularly the elderly, and is associated with increased mortality, length of hospital stay, and risk of long-term cognitive impairment. | ||
== Etiology == | == Etiology == | ||
Delirium is typically caused by one or more contributing factors. It is often precipitated by physical illness, surgery, or drugs, particularly in individuals with pre-existing brain pathology or systemic disease. Common causes include infections, metabolic disturbances (e.g., [[hyperglycemia]], [[hypoglycemia]], [[hypernatremia]], [[hyponatremia]]), withdrawal states (e.g., alcohol or benzodiazepine withdrawal), central nervous system disorders, and certain medications (e.g., anticholinergics, opioids, benzodiazepines). | Delirium is typically caused by one or more contributing factors. It is often precipitated by physical illness, surgery, or drugs, particularly in individuals with pre-existing brain pathology or systemic disease. Common causes include infections, metabolic disturbances (e.g., [[hyperglycemia]], [[hypoglycemia]], [[hypernatremia]], [[hyponatremia]]), withdrawal states (e.g., alcohol or benzodiazepine withdrawal), central nervous system disorders, and certain medications (e.g., anticholinergics, opioids, benzodiazepines). | ||
== Clinical Features == | == Clinical Features == | ||
*Delirium is characterized by a rapid onset of symptoms, fluctuating course throughout the day, trouble with attention, and either disorganized thinking or altered level of consciousness. There are three types of delirium: | *Delirium is characterized by a rapid onset of symptoms, fluctuating course throughout the day, trouble with attention, and either disorganized thinking or altered level of consciousness. There are three types of delirium: | ||
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*'''Mixed delirium:''' Patients fluctuate between hyperactive and hypoactive states. | *'''Mixed delirium:''' Patients fluctuate between hyperactive and hypoactive states. | ||
*Patients with delirium may also experience hallucinations, delusions, and emotional disturbances, such as fear or anxiety. | *Patients with delirium may also experience hallucinations, delusions, and emotional disturbances, such as fear or anxiety. | ||
== Diagnosis == | == Diagnosis == | ||
The diagnosis of delirium is mainly clinical, based on history and physical examination. Tools like the Confusion Assessment Method (CAM) can help to standardize the diagnostic process. Laboratory tests and imaging are often used to identify underlying causes. | The diagnosis of delirium is mainly clinical, based on history and physical examination. Tools like the Confusion Assessment Method (CAM) can help to standardize the diagnostic process. Laboratory tests and imaging are often used to identify underlying causes. | ||
== Treatment == | == Treatment == | ||
Treatment of delirium focuses on addressing the underlying cause, ensuring patient safety, and managing symptoms. Non-pharmacological strategies are first-line, including reorientation, maintaining a regular sleep-wake cycle, adequate hydration, and early mobilization. Pharmacological treatment with antipsychotic medications may be considered for severe agitation or distress, but they should be used with caution due to potential side effects. | Treatment of delirium focuses on addressing the underlying cause, ensuring patient safety, and managing symptoms. Non-pharmacological strategies are first-line, including reorientation, maintaining a regular sleep-wake cycle, adequate hydration, and early mobilization. Pharmacological treatment with antipsychotic medications may be considered for severe agitation or distress, but they should be used with caution due to potential side effects. | ||
== Prevention == | == Prevention == | ||
Preventing delirium involves recognizing patients at high risk and intervening to minimize precipitating factors. This might involve avoiding high-risk medications, promoting good sleep hygiene, maintaining proper hydration and nutrition, and encouraging early mobility. | Preventing delirium involves recognizing patients at high risk and intervening to minimize precipitating factors. This might involve avoiding high-risk medications, promoting good sleep hygiene, maintaining proper hydration and nutrition, and encouraging early mobility. | ||
== See Also == | == See Also == | ||
* [[Confusion]] | * [[Confusion]] | ||
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* [[ICU syndrome]] | * [[ICU syndrome]] | ||
* [[Postoperative delirium]] | * [[Postoperative delirium]] | ||
== References == | == References == | ||
<references> | <references> | ||
Latest revision as of 01:19, 6 April 2025
Editor-In-Chief: Prab R Tumpati, MD
Obesity, Sleep & Internal medicine
Founder, WikiMD Wellnesspedia &
W8MD's medical weight loss NYC, sleep center NYC
Philadelphia medical weight loss and Philadelphia sleep clinics
| Delirium | |
|---|---|
| |
| Synonyms | N/A |
| Pronounce | N/A |
| Specialty | N/A |
| Symptoms | Confusion, disorientation, hallucinations, agitation, inattention |
| Complications | N/A |
| Onset | Rapid |
| Duration | Hours to days |
| Types | N/A |
| Causes | Infection, substance intoxication, substance withdrawal, metabolic disorders, trauma, surgery |
| Risks | Elderly, hospitalization, dementia, polypharmacy |
| Diagnosis | Clinical assessment, Confusion Assessment Method |
| Differential diagnosis | Dementia, psychosis, depression |
| Prevention | N/A |
| Treatment | Address underlying cause, antipsychotics, supportive care |
| Medication | N/A |
| Prognosis | Variable, depends on underlying cause |
| Frequency | Common in hospitalized patients, especially the elderly |
| Deaths | N/A |
Delirium is an acute and usually reversible disturbance in mental function, characterized by a fluctuating course, inattention, and either altered level of consciousness or cognitive dysfunction. It represents a serious and common complication in hospitalized patients, particularly the elderly, and is associated with increased mortality, length of hospital stay, and risk of long-term cognitive impairment.
Etiology[edit]
Delirium is typically caused by one or more contributing factors. It is often precipitated by physical illness, surgery, or drugs, particularly in individuals with pre-existing brain pathology or systemic disease. Common causes include infections, metabolic disturbances (e.g., hyperglycemia, hypoglycemia, hypernatremia, hyponatremia), withdrawal states (e.g., alcohol or benzodiazepine withdrawal), central nervous system disorders, and certain medications (e.g., anticholinergics, opioids, benzodiazepines).
Clinical Features[edit]
- Delirium is characterized by a rapid onset of symptoms, fluctuating course throughout the day, trouble with attention, and either disorganized thinking or altered level of consciousness. There are three types of delirium:
- Hyperactive delirium: Patients may be restless, agitated, or aggressive.
- Hypoactive delirium: Patients are drowsy, inactive, and slow to respond.
- Mixed delirium: Patients fluctuate between hyperactive and hypoactive states.
- Patients with delirium may also experience hallucinations, delusions, and emotional disturbances, such as fear or anxiety.
Diagnosis[edit]
The diagnosis of delirium is mainly clinical, based on history and physical examination. Tools like the Confusion Assessment Method (CAM) can help to standardize the diagnostic process. Laboratory tests and imaging are often used to identify underlying causes.
Treatment[edit]
Treatment of delirium focuses on addressing the underlying cause, ensuring patient safety, and managing symptoms. Non-pharmacological strategies are first-line, including reorientation, maintaining a regular sleep-wake cycle, adequate hydration, and early mobilization. Pharmacological treatment with antipsychotic medications may be considered for severe agitation or distress, but they should be used with caution due to potential side effects.
Prevention[edit]
Preventing delirium involves recognizing patients at high risk and intervening to minimize precipitating factors. This might involve avoiding high-risk medications, promoting good sleep hygiene, maintaining proper hydration and nutrition, and encouraging early mobility.
See Also[edit]
References[edit]
<references>
- Inouye SK, Westendorp RG, Saczynski JS. (2014). Delirium in elderly people. Lancet, 383(9920), 911-922.
- Davis DH, Muniz Terrera G, Keage H, Rahkonen T, Oinas M, Matthews FE, Cunningham C, Polvikoski T, Sulkava R, MacLullich AM, Brayne C. (2017). Delirium is a strong risk factor for dementia in the oldest-old: a population-based cohort study. Brain, 140(9), 2809-2816.
- Oh ES, Fong TG, Hshieh TT, Inouye SK. (2017). Delirium in Older Persons: Advances in Diagnosis and Treatment. JAMA, 318(12), 1161-1174.
</references>
