Overview Delirium is a neuropsychiatric syndrome characterized by a disturbance in consciousness and cognition. It typically presents as an acute confusional state, with inattention as its core symptom. Unfortunately, the diagnosis of delirium is often delayed or missed, especially the hypoactive form that is common in older persons.
| Definition Delirium: Cognitive impairment typically caused by acute illness or drug toxicity (sometimes life threatening) and is often reversible. Delirium mainly affects attention. Confusion: disturbed orientation in regard to time, place, or person, sometimes accompanied by disordered Dementia: Cognitive impairment typically caused by anatomic changes in the brain, has slower onset, and is generally irreversible. Dementia mainly affects memory. |
| Remember Confusion is not specific to delirium; it may be found in other psychiatric disorders, such as dementia or depression. |
| Difference between Dementia and Delirium | ||
| Dementia | Delirium | |
| Onset | Sub-acute | Acute |
| Conscious level | Normal | Fluctuates |
| Hallucinations | Late event | Common |
| Agitation/agression | Uncommon until late | Common |
| Thought form | Poverty of thought late | Flight of ideas |
| Memory | Slow decline | Poor |
There are two important aspects to the diagnostic evaluation of delirium: recognizing that the disorder is present and uncovering the underlying medical illness that has caused delirium.
Diagnosis Delirium is a clinical diagnosis. Thorough chart review is essential in making a proper diagnosis.
Diagnostic and Statistical Manual, 5th edition (DSM-V) for delirium:
Additional features that may accompany delirium and confusion include the following:
A particular case of delirium is often multifactorial. One or more precipitating factors combine to push a predisposed patient across his or her threshold to delirium.
Precipitating factors
| Drugs causing delirium |
| Anticholinergics |
| Benzodiazepines |
| Antipsychotics |
| Anticonvulsants |
| Tricyclic Antidepressants |
| Lithium |
| Opiates |
| Alcohol |
| AntiParkinsons |
| Diuretics |
| Corticosteroids |
| Remember Polypharmacy is a risk factor for developing delirium. Make sure to review medications |
| Remember There are two important aspects to the diagnostic evaluation of delirium: recognizing that the disorder is present and uncovering the underlying medical illness that has caused delirium. |
Non-Pharmacological
Pharmacological
