Diseases & Conditions


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Delirium


Delirium is a disturbance of consciousness (awareness of the person's environment) characterized by altered or shifting mental status and inattention (reduced ability to focus, sustain, or shift attention). There are also changes in cognition (basic mental functions) such as memory impairment, disorientation to time or place, and language disturbance. There also may be disturbances of perception (accurate appreciation of the environment) such as hallucinations (seeing or hearing things that are not actually there), abnormal speech, abnormal movements (including tremors or picking at clothing), disruptive or violent behavior, and sudden shifts in emotions. To qualify for a diagnosis of delirium, the signs and symptoms must have a short onset (over a period of hours or days) and change over the course of the day. It is important to make a clear distinction between delirium and dementia (such as Alzheimer disease). Dementia is a disturbance in intellectual (thinking) functions that is usually gradually progressive over a long period. Having delirium along with another medical illness can significantly increase a person's chance of dying from that illness. It is important for doctors to identify delirium so that it can be treated to improve the person's overall prognosis. CAUSES OF DELIRIUM New or worsening medical illnesses such as severe infections or heart failure Medications, abused drugs, or poisons Drug withdrawal syndromes, such as delirium tremens (delirium from alcohol withdrawal) Psychiatric (mental) illnesses Severe pain, immobilization, or sleep deprivation TREATMENTS FOR DELIRIUM Identifying and treating the underlying cause of delirium is essential. Supportive care, including mechanical ventilation and life-support medications, may be necessary. The need for all medications the patient is receiving should be assessed. Replacement of vitamin B should be considered for persons with alcoholism or who are malnourished. Antipsychotic medications may be used to reduce the symptoms of delirium. Benzodiazepines (antianxiety medications) may be used, particularly in cases of drug withdrawal syndromes. If no other treatments are effective and the patient is at clear risk of harm to self or others, soft restraints may be needed for a short time. Psychiatric assessment and management are important, particularly in cases of delirium not easily explainable by poison exposure, medication effects, or medical illness. FOR MORE INFORMATION American Psychiatric Association http://www.psych.org Brain Dysfunction in Critically Ill Patients http://www.icudelirium.org National Institute of Mental Health http://www.nimh.nih.gov Source: JAMA. 2008;300(24):2936.