Delirium

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 Still 7

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).

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:
• 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

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 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

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

• Confusion
• Dementia
• Depression
• ICU syndrome
• Postoperative delirium

References

<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.

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