| Delirium | |
|---|---|
| Other names | Acute confusional state |
_(14592098880).jpg) | |
| Delirium is an acute disturbance of mental abilities | |
| Specialty | Psychiatry, geriatrics |
| Symptoms | Changes in attention, activity, awareness, sleep patterns, ability to think[1] |
| Usual onset | > 70 years old[2] |
| Duration | 1 week[1] |
| Types | Hyperactive, hypoactive, mixed[3] |
| Causes | Medical conditions, medications, substance intoxication, substance withdrawal[2] |
| Risk factors | Dementia, vision problems, hearing problems, alcoholism[2] |
| Differential diagnosis | Psychosis, dementia, acute stress disorder[2][1] |
| Treatment | Treating underlying cause, good general care[2][4] |
| Medication | Antipsychotics (haloperidol)[2] |
| Frequency | 1 to 2% of people[1] |
Delirium, also known as acute confusional state, is an altered level of consciousness that develops over a short period and fluctuates over time.[2] There may be changes in attention, activity, awareness, sleep patterns, and ability to think.[1] Onset is typically over hours to days and the person differs from their usual baseline mental functioning.[1] In hospital, the condition typically lasts about a week, though some may have ongoing problems afterwards.[1]
Delirium may be caused by a medical condition, medications, substance intoxication, or substance withdrawal.[2] Often a number of factors are involved.[2] Risk factors include dementia, vision problems, hearing problems, and alcoholism.[2] Medications that may trigger the event include benzodiazepines, antihistamines, opioids, and antipsychotics.[2] Other triggers may include infections, pain, or surgery.[2] The underlying mechanism poorly understood.[2]
Diagnose requires establishing a person's usual mental function.[2] The person's activity may be increased (agitation), decreased (subdued), or be a mix of both.[3] Cases were activity is decreased are more frequently missed or attributed to depression.[3] It should be distinguished from psychotic disorders, acute stress disorder, and dementia.[1]
Treatment is generally directed at the underlying causes.[2] Other measures may include hearing aids, glasses, sufficient fluids to drink, a quiet sleep environment, and a visible clock.[2] While antipsychotics are used, there is no evidence to support a benefit for delirium.[2][5][6] Delirium in hospitalized people; however, can be reduced by systematic good general care.[4] About 40% of people with delirium in hospital die within a year.[1]
Delirium affects about 1 to 2% of people overall.[1] Among older adults, rates are around 20% after surgery or when visiting the emergency department, and up to 90% in the intensive care unit.[1][2] Rates around 20% are also seen among those admitted to hospital.[1] The condition becomes more common with age, affecting about 14% of those over the age of 85.[1] Descriptions of delirium date back to at least Hippocrates around 400 BC.[7]
References edit
- ^ a b c d e f g h i j k l m Diagnostic and statistical manual of mental disorders : DSM-5 (Fifth ed.). Arlington, VA: American Psychiatric Association. 2013. p. 596-601. ISBN 9780890425596. OCLC 847226928.
- ^ a b c d e f g h i j k l m n o p q r Ramírez Echeverría, MdL; Paul, M (January 2020). "Delirium". PMID 29261982.
{{cite journal}}: Cite journal requires|journal=(help) - ^ a b c Gleason OC (March 2003). "Delirium". American Family Physician. 67 (5): 1027–34. PMID 12643363. Archived from the original on 2011-06-06.
- ^ a b 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" (PDF). The Cochrane Database of Systematic Reviews. 3: CD005563. doi:10.1002/14651858.CD005563.pub3. PMID 26967259. Open access repository
- ^ 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): 705–14. doi:10.1111/jgs.14076. PMC 4840067. PMID 27004732.
- ^ Burry L, Mehta S, Perreault MM, Luxenberg JS, Siddiqi N, Hutton B, et al. (June 2018). "Antipsychotics for treatment of delirium in hospitalised non-ICU patients". The Cochrane Database of Systematic Reviews. 6: CD005594. doi:10.1002/14651858.CD005594.pub3. PMC 6513380. PMID 29920656.
- ^ Lindesay, James; Rockwood, Kenneth; Macdonald, Alastair (2002). Delirium in Old Age. Oxford University Press. p. 1. ISBN 978-0-19-263275-3.