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DELIRIUM
 

Prediction: Less Than 1 Week

      Occupational-Economic:
  • Unable to work due to confusion
  • Impaired cognitive functioning (concentration, alertness, disorientation, memory, apathy, executive functioning, language, perception) fluctuates during the day
      Social:
  • Negative emotion (anxiety, depression)
  • Antagonism (hostility)
  • Disinhibition (agitation, euphoria)
      Medical:
  • Complications depend on underlying physical cause; full recovery is common if underlying physical cause is corrected

SYNOPSIS

Delirium, Not Induced By Alcohol And Other Psychoactive Substances F05 - ICD10 Description, World Health Organization
An etiologically nonspecific organic cerebral syndrome characterized by concurrent disturbances of consciousness and attention, perception, thinking, memory, psychomotor behaviour, emotion, and the sleep-wake schedule. The duration is variable and the degree of severity ranges from mild to very severe.
Delirium - Diagnostic Criteria, American Psychiatric Association

An individual diagnosed with delirium needs to meet all of the following criteria:

  • A disturbance in attention (i.e., reduced ability to direct, focus, sustain, and shift attention) and awareness (reduced orientation to the environment).

  • The disturbance develops over a short period of time (usually hours to a few days), represents a change from baseline attention and awareness, and tends to fluctuate during the course of the day.

  • An additional disturbance in cognition (e.g., memory deficit, disorientation, language, visuospatial ability, or perception).

  • These cognitive disturbances are not better explained by another preexisting, established, or evolving neurocognitive disorder and do not occur in the context of a severely reduced level of arousal, such as coma.

  • There is evidence from the history, physical examination, or laboratory findings that the disturbance is a direct physiological consequence of another medical condition, substance intoxication or withdrawal (i.e., due to a drug of abuse or to a medicatioin), or exposure to a toxin, or is due to multiple etiologies.

Delirium is a potentially life-threatening disorder characterized by an acute, fluctuating change in mental status, with inattention, disorganized thinking, and altered levels of consciousness. The individual with this disorder may be hyperactive, hypoactive, or a mixture of both. Treatment should immediately attempt to treat the physical cause of the delirium. New-onset stroke or transient ischemic attack, subdural hematoma, epilepsy, meningitis, encephalitis, brain abscess, and neurosyphilis can cause delirium. Delirium is often the only symptom of myocardial infarction, urinary tract infection and pneumonia in older people. Other causes of delirium are: hypoxia, pulmonary embolism, alcoholic ketoacidosis, hip fracture, metabolic abnormalities, hypoglycemia or hyperglycemia, drug toxicity, drug withdrawal (benzodiazepine, alcohol), acute psychosis, advanced cancer, endocrine abnormalities (hypothyroidism, adrenal crisis), and urinary obstruction.

Effective Therapies

Outcome depends on the physical cause of the delirium. Antipsychotic medication [1], high-dose lorazepam, or electroconvulsive therapy (ECT) is effective for the delirium caused by bipolar I disorder [2] [3]. Neuroleptic malignant syndrome (caused by antipsychotic medication) and serotonin syndrome (caused by SSRI antidepressant medication) can both cause delirium. Many other medications and medical disorders can cause delirium.

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