Delirium
| Subclass of | Q57823731, cognitive disorder, neurological and physiological symptom, mental confusion  |
|---|---|
| Health specialty | psychiatry, neurology, psychology |
| Medical examination | NEECHAM Confusion Scale |
| Drug or therapy used for treatment | haloperidol, trazodone |
| WordLift URL | http://data.medicalrecords.com/medicalrecords/healthwise/delirium_pdq__supportive_care_-_patient_information_nci |
| ICPC 2 ID | P71 |
| NCI Thesaurus ID | C2981 |
Delirium (formerly acute confusional state, an ambiguous term wey now dem discourage)[1] be a specific state of acute confusion attributable to de direct physiological consequence of a medical condition, effects of a psychoactive substance, anaa multiple causes, wich dey usually develop over de course of hours to days.[2][3] As a syndrome, delirium dey present plus disturbances in attention, awareness, den higher-order cognition. People plus delirium fi experience oda neuropsychiatric disturbances wey dey include changes in psychomotor activity (e.g., hyperactive, hypoactive, anaa mixed level of activity), disrupted sleep-wake cycle, emotional disturbances, disturbances of consciousness, anaa altered state of consciousness, as well as perceptual disturbances (e.g., hallucinations den delusions), although dese features no be required for diagnosis.
Diagnostically, delirium dey encompass both de syndrome of acute confusion den ein underlying organic process[3] dem know as an acute encephalopathy.[1] De cause of delirium fi be either a disease process inside de brain anaa a process outside de brain wey nonetheless dey affect de brain. Delirium fi be de result of an underlying medical condition (e.g., infection anaa hypoxia), side effect of a medication such as diphenhydramine, promethazine, den dicyclomine, substance intoxication (e.g., opioids anaa hallucinogenic deliriants), substance withdrawal (e.g., alcohol anaa sedatives), anaa from multiple factors wey dey affect one ein overall health (e.g., malnutrition, pain, etc.). In contrast, de emotional den behavioral features secof primary psychiatric disorders (e.g., as insyd schizophrenia, bipolar disorder) no dey meet de diagnostic criteria for 'delirium'.[2]
Delirium fi be difficult to diagnose widout first establishing a person ein usual mental function anaa 'cognitive baseline'. Delirium fi be confused plus chaw psychiatric disorders anaa chronic organic brain syndromes secof chaw overlapping signs den symptoms in common plus dementia, depression, psychosis, etc.[4][5] Delirium fi occur in persons plus existing mental illness, baseline intellectual disability, anaa dementia, entirely unrelated to any of dese conditions. Delirium often be confused plus schizophrenia, psychosis, organic brain syndromes, den more, secof similar signs den symptoms of dese disorders.
Treatment of delirium dey require identifying den managing de underlying causes, managing delirium symptoms, den reducing de risk of complications.[6] Insyd sam cases, dem dey use temporary anaa symptomatic treatments to comfort de person anaa to facilitate oda care (e.g., dey prevent people from pulling out a breathing tube). Antipsychotics no be supported for de treatment anaa prevention of delirium among those wey dey insyd hospital; however, dem fi be used insyd cases wer na a person get distressing experiences such as hallucinations anaa if de person dey pose a danger to demaselves anaa odas.[7][8][9][10][11] Wen delirium be caused by alcohol anaa sedative-hypnotic withdrawal, dem typically dey use benzodiazepines as a treatment.[12] Der be evidence say de risk of delirium insyd hospitalized people fi be reduced by non-pharmacological care bundles (spy Delirium § Prevention).[9] According to de text of DSM-5-TR, although delirium dey affect 1–2% per of de overall population, 18–35% of adults wey dey present to de hospital go get delirium, den delirium go occur insyd 29–65% of people wey be hospitalized.[3] Delirium dey occur insyd 11–51% of older adults after surgery, insyd 81% of those insyd de ICU, den insyd 20–22% of individuals insyd nursing homes anaa post-acute care settings.[3] Among those wey dey require critical care, delirium be a risk factor for death within de next year.[3][13]
Secof de confusion wey be caused by similar signs den symptoms of delirium plus oda neuropsychiatric disorders like schizophrenia den psychosis, treating delirium fi be difficult, den even fi cause death of de patient secof dem dey treat am plus de wrong medications.[14][15][16]
References
[edit | edit source]- 1 2 Slooter AJ, Otte WM, Devlin JW, Arora RC, Bleck TP, Claassen J, Duprey MS, Ely EW, Kaplan PW, Latronico N, Morandi A, Neufeld KJ, Sharshar T, MacLullich AM, Stevens RD (May 2020). "Updated nomenclature of delirium and acute encephalopathy: statement of ten Societies". Intensive Care Medicine. 46 (5): 1020–1022. doi:10.1007/s00134-019-05907-4. PMC 7210231. PMID 32055887.
- 1 2 Wilson JE, Mart MF, Cunningham C, Shehabi Y, Girard TD, MacLullich AM, Slooter AJ, Ely EW (November 2020). "Delirium". Nature Reviews. Disease Primers. 6 (1) 90. doi:10.1038/s41572-020-00223-4. PMC 9012267. PMID 33184265. S2CID 226302415.
- 1 2 3 4 5 "Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision (DSM-5-TR™)". American Psychiatric Association. Archived from the original on April 22, 2022. Retrieved April 18, 2022.
- ↑ Gleason OC (March 2003). "Delirium". American Family Physician. 67 (5): 1027–1034. PMID 12643363. Archived from the original on 2011-06-06.
- ↑ Wilson JE, Andrews P, Ainsworth A, Roy K, Ely EW, Oldham MA (Fall 2021). "Pseudodelirium: Psychiatric Conditions to Consider on the Differential for Delirium". The Journal of Neuropsychiatry and Clinical Neurosciences. 33 (4): 356–364. doi:10.1176/appi.neuropsych.20120316. PMC 8929410. PMID 34392693.
- ↑ "SIGN 157 Delirium". www.sign.ac.uk. Archived from the original on 2022-12-06. Retrieved 2020-05-15.
- ↑ Devlin JW, Skrobik Y, Gélinas C, Needham DM, Slooter AJ, Pandharipande PP, Watson PL, Weinhouse GL, Nunnally ME, Rochwerg B, Balas MC, van den Boogaard M, Bosma KJ, Brummel NE, Chanques G, Denehy L, Drouot X, Fraser GL, Harris JE, Joffe AM, Kho ME, Kress JP, Lanphere JA, McKinley S, Neufeld KJ, Pisani MA, Payen JF, Pun BT, Puntillo KA, Riker RR, Robinson BR, Shehabi Y, Szumita PM, Winkelman C, Centofanti JE, Price C, Nikayin S, Misak CJ, Flood PD, Kiedrowski K, Alhazzani W (September 2018). "Clinical Practice Guidelines for the Prevention and Management of Pain, Agitation/Sedation, Delirium, Immobility, and Sleep Disruption in Adult Patients in the ICU". Critical Care Medicine. 46 (9): e825 – e873. doi:10.1097/CCM.0000000000003299. PMID 30113379.
- ↑ Santos CD, Rose MQ (June 2021). "Extrapyramidal Symptoms Induced by Treatment for Delirium: A Case Report". Critical Care Nurse. 41 (3): 50–54. doi:10.4037/ccn2021765. PMID 34061189.
- 1 2 Siddiqi N, Harrison JK, Clegg A, Teale EA, Young J, Taylor J, Simpkins SA (March 2016). "Interventions for preventing delirium in hospitalised non-ICU patients". The Cochrane Database of Systematic Reviews. 2016 (3) CD005563. doi:10.1002/14651858.CD005563.pub3. PMC 10431752. PMID 26967259.
- ↑ Neufeld KJ, Yue J, Robinson TN, Inouye SK, Needham DM (April 2016). "Antipsychotic Medication for Prevention and Treatment of Delirium in Hospitalized Adults: A Systematic Review and Meta-Analysis". Journal of the American Geriatrics Society. 64 (4): 705–714. doi:10.1111/jgs.14076. PMC 4840067. PMID 27004732.
- ↑ Burry L, Mehta S, Perreault MM, Luxenberg JS, Siddiqi N, Hutton B, Fergusson DA, Bell C, Rose L (June 2018). "Antipsychotics for treatment of delirium in hospitalised non-ICU patients". The Cochrane Database of Systematic Reviews. 2018 (6) CD005594. doi:10.1002/14651858.CD005594.pub3. PMC 6513380. PMID 29920656. Archived from the original on 2019-11-07. Retrieved 2019-11-07.
- ↑ Attard A, Ranjith G, Taylor D (August 2008). "Delirium and its treatment". CNS Drugs. 22 (8): 631–644. doi:10.2165/00023210-200822080-00002. PMID 18601302. S2CID 94743.
- ↑ Ely EW, Shintani A, Truman B, Speroff T, Gordon SM, Harrell FE, Inouye SK, Bernard GR, Dittus RS (April 2004). "Delirium as a predictor of mortality in mechanically ventilated patients in the intensive care unit". JAMA. 291 (14): 1753–1762. doi:10.1001/jama.291.14.1753. PMID 15082703.
- ↑ Dharmarajan K, Swami S, Gou RY, Jones RN, Inouye SK (May 2017). "Pathway from Delirium to Death: Potential In-Hospital Mediators of Excess Mortality". Journal of the American Geriatrics Society. 65 (5): 1026–1033. doi:10.1111/jgs.14743. PMC 5435507. PMID 28039852.
- ↑ Rockwood K, Cosway S, Carver D, Jarrett P, Stadnyk K, Fisk J (October 1999). "The risk of dementia and death after delirium". Age and Ageing. 28 (6): 551–556. doi:10.1093/ageing/28.6.551. PMID 10604507.
- ↑ Leslie DL, Zhang Y, Holford TR, Bogardus ST, Leo-Summers LS, Inouye SK (July 2005). "Premature death associated with delirium at 1-year follow-up". Archives of Internal Medicine. 165 (14): 1657–1662. doi:10.1001/archinte.165.14.1657. PMID 16043686.
Read further
[edit | edit source]- Macdonald A, Lindesay J, Rockwood K (2002). Delirium in old age. Oxford [Oxfordshire]: Oxford University Press. ISBN 978-0-19-263275-3.
- Grassi L, Caraceni A (2003). Delirium: acute confusional states in palliative medicine. Oxford: Oxford University Press. ISBN 978-0-19-263199-2.
- Newman JK, Slater CT, eds. (2012). Delirium: causes, diagnosis and treatment. Hauppauge, N.Y.: Nova Science Publisher's, Inc. ISBN 978-1-61324-294-0.
