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Delirium

Aka: Delirium
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  1. See Also
    1. Altered Level of Consciousness
    2. Delirium in Cancer
  2. Definition
    1. Acute Confusional State
  3. Risk Factors
    1. Age over 60 years
    2. Drug or Alcohol addiction and withdrawal
    3. Prior brain injury (vascular or traumatic injury)
    4. Hearing Loss or Decreased Visual Acuity
    5. Insomnia or other sleep deprivation
    6. Polypharmacy
    7. Hospitalization or post-surgery
    8. Multiple comorbid conditions
    9. Poor nutritional status
    10. Hepatic failure
    11. Chronic Renal Failure
    12. Poor nutritional status
  4. Precipitating Factors
    1. Infection
    2. Dehydration
    3. Electrolyte abnormalities
    4. Myocardial Infarction
    5. Arrhythmia
    6. Sleep Deprivation
    7. More than 3 medications added within 24 hours
    8. Psychoactive medications
  5. Criteria
    1. Rapid deterioration in all higher cortical functions
    2. Mental status fluctuates widely
    3. Short duration of symptoms (Hours to days)
    4. Disturbance in both Level of Consciousness and content
    5. Autonomic Instability (Abnormal vital signs)
  6. Signs
    1. Fluctuating levels of consciousness
      1. Inattention
      2. Perseveration
      3. Decreased alertness
      4. Disorientation
      5. Extremes of activity
        1. Somnolence to agitation
    2. Disorganized thought processes (Delusions)
    3. Memory Impairment (especially short term)
    4. Perceptual disturbances
      1. Persecutory Delusions are common
      2. Visual hallucinations rare except in organic cause
    5. Emotional lability
    6. Motor changes
      1. Myoclonus
      2. Asterixis
  7. Course
    1. Reversible in over 80% of cases
  8. Evaluation
    1. See Confusion Assessment Method
    2. See Altered Level of Consciousness (includes labs)
    3. Electroencephalogram
      1. Diffuse slow waves
  9. Differential Diagnosis
    1. See Altered Level of Consciousness Causes
    2. Dementia
    3. Psychosis
    4. Major Depression
  10. Management: Pharmacologic
    1. Precautions
      1. Antipsychotics are associated with increased mortality in the elderly
      2. Use only short-term and only when non-pharmacologic measures fail
      3. Limit to monitored settings
      4. See each agent for contraindications and adverse effects before use
    2. Agents: First-Line
      1. Haloperidol 0.5 to 1 mg orally twice daily
    3. Agents: Second-line
      1. Risperidone (Risperdal) 0.5 mg orally twice daily
      2. Olanzapine (Zyprexa) 2.5 to 5 mg orally twice daily
      3. Quetiapine (Seroquel) 25 mg orally twice daily
    4. Agents: Other
      1. Lorazepam 0.5 to 1 mg orally every 4 hours as needed
        1. Limit to Parkinson Disease, Drug Withdrawal, Neuroleptic Malignant Syndrome
  11. Prevention
    1. Optimize hydration and nutrition
    2. Early mobilization of patients
    3. Avoid sedatives for sleep (see Sleep Hygiene)
    4. Reduce restraints and catheters
    5. Reorient patient frequently (involve family presence)
    6. Correct vision and hearing
    7. Avoid psychoactive medications
      1. Anticholinergic Medications
      2. Benzodiazepines
      3. Narcotics
  12. References
    1. Cole (2004) Am J Geriatr Psychiatry 12(1):7-21
    2. Inouye (2006) N Engl J Med 354(11): 1157-65
    3. Miller (2008) Am Fam Physician 78(11): 1265-70

Delirium (C0011206)

Definition (NCI) A usually reversible condition characterized by the acute and sudden development of confusion, illusions, movement changes, inattentiveness, agitation, and hallucinations. Causes include drug abuse, poisoning, infectious processes, and fluid and electrolyte imbalance.
Definition (NCI) A disorder characterized by the acute and sudden development of confusion, illusions, movement changes, inattentiveness, agitation, and hallucinations. Usually, it is a reversible condition.
Definition (MEDLINEPLUS)

Delirium is a condition which causes a confused mental state and changes in behavior. Besides falling in and out of consciousness, there may be problems with

  • Attention and awareness
  • Thinking and memory
  • Emotion
  • Muscle control
  • Sleeping and waking

Causes of delirium include medications, poisoning, serious illnesses or infections, and severe pain. It can also be part of some mental illnesses or dementia. Delirium and dementia have similar symptoms, so it can be hard to tell them apart. They can also occur together.

Delirium tremens is a serious type of alcohol withdrawal syndrome. It usually happens to people who stop drinking after years of alcohol abuse.

People with delirium often, though not always, make a full recovery after their underlying illness is treated.
Definition (NCI) A mental state in which a person is confused, disoriented, and not able to think or remember clearly. The person may also be agitated and have hallucinations, and extreme excitement.
Definition (MSH) A disorder characterized by CONFUSION; inattentiveness; disorientation; ILLUSIONS; HALLUCINATIONS; agitation; and in some instances autonomic nervous system overactivity. It may result from toxic/metabolic conditions or structural brain lesions. (From Adams et al., Principles of Neurology, 6th ed, pp411-2)
Definition (CSP) disorder characterized by confusion, inattentiveness, disorientation, illusions, hallucinations, agitation and in some instances autonomic nervous system overactivity; may result from toxic or metabolic conditions or structural brain lesions; condition may also be acute and reversible.
Concepts Mental or Behavioral Dysfunction (T048)
MSH D003693
ICD10 F05.9, R41.0
SnomedCT 2776000, 154859007, 231441005, 35610006, 192186000, 419567006
DSM4 780.09
English Delirium, Acute delirium, ACUTE BRAIN SYNDROME, BRAIN SYNDROME ACUTE, DELIRIUM, Delirium NOS, SYNDROME BRAIN ACUTE, acute delirium, Acute brain syndrome, NOS, Delirium, NOS, Delirium, unspecified, [X]Delirium, unspecified, delirium (symptom), delirium, Acute brain syndrome (disorder), Brain syndrome acute, Syndrome brain acute, DELIRIUM ACUTE, [X]Delirium, unspecified (disorder), Delirium [Disease/Finding], deliria, acute brain syndrome, Deliria, delirious, Acute brain syndrome, ABS - Acute brain syndrome, Delirium (disorder), Delirious, Delirious (finding)
French DELIRE, Syndrome cérébral aigu, Délire aigu, Délirant(e), Délirium, SYNDROME ENCEPHALIQUE AIGU, Délire, Délires, Délire avec confusion, Délire confusionnel
Portuguese DELIRIO, Síndrome cerebral aguda, Delirante, Delírio agudo, SINDROME CEREBRAL AGUDO, Deliria, Delirium, Delírio
Spanish DELIRIO, con delirio (hallazgo), con delirio, delira, Síndrome cerebral agudo, Delirio agudo, Desvarío, Delirium, SINDROME CEREBRAL AGUDO, [X]delirio, no especificado, [X]delirio, no especificado (trastorno), delirio (trastorno), delirio, síndrome cerebral agudo (concepto no activo), síndrome cerebral agudo, Delirios, Delirio
German DELIRIUM, akutes Hirnsyndrom, akutes Delirium, Syndrom Gehirn akut, Hirnsyndrom akut, deliroes, Delir, nicht naeher bezeichnet, HIRNSYNDROM AKUT, Delirien, Delirium, Delir
Italian Deliri, Vaneggiamento, Delirio acuto, Sindrome cerebrale acuta, Delirante, Delirio
Dutch acuut delirium, delirant, delier acuut, acuut delier, acuut hersensyndroom, Delirium, niet gespecificeerd, deliriums, delirium, Delirium
Japanese 急性脳症候群, 急性譫妄, ｷｭｳｾｲﾉｳｼｮｳｺｳｸﾞﾝ, ｷｭｳｾｲｾﾝﾓｳ, ｾﾝﾓｳ, うわごと, せん妄, 譫妄
Swedish Delirium
Czech delirium, Delirium, Akutní organický mozkový syndrom, Blouznící, Deliria, Akutní organický psychosyndrom, Akutní delirium
Finnish Delirium
Russian DELIRII, ДЕЛИРИЙ
Korean 상세불명의 섬망
Polish Delirium, Bredzenie, Majaczenie
Hungarian Delirium, Acut agyi syndroma, Heveny agyi syndroma, Acut delirium, Delírium, Delirosus
Sources
Derived from the NIH UMLS (Unified Medical Language System)


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