Delirium differential diagnosis: Difference between revisions

Jump to navigation Jump to search
VisualWikitext
No edit summary
 
(63 intermediate revisions by 3 users not shown)
Line 1: Line 1:
__NOTOC__
__NOTOC__
{{Delirium}}
{{Delirium}}
{{CMG}}; {{AE}} [[User:Vishal Khurana|Vishal Khurana]], M.B.B.S., M.D. [mailto:vishdoc24@gmail.com]
{{CMG}}; {{AE}} {{PB}}; [[User:Vishal Khurana|Vishal Khurana]], M.B.B.S., M.D. [mailto:vishdoc24@gmail.com]


==Overview==
==Overview==
==Common usage of the term versus standard medical usage==
[[Delirium]] is differentiated from other causes [[cognitive]] dysfunction such as  [[psychiatric Disorders]], [[dementia]]. Unlike [[dementia]], the course of [[delirium]] is reversible with fluctuation in level of [[consciousness]].


In common usage, delirium is often used to refer to drowsiness and disorientation. In broader [[medical terminology]], however, a number of other symptoms, including sudden inability of focus attention, and even (occasionally) sleeplessness and severe agitation and irritability, are also defined as "delirium."
==Differential Diagnosis==
*Shown below the table of differentiating [[delirium]] from other [[psychiatric]] disorders:<ref name="pmid30773695">{{cite journal |vauthors=Fong TG, Vasunilashorn SM, Libermann T, Marcantonio ER, Inouye SK |title=Delirium and Alzheimer disease: A proposed model for shared pathophysiology |journal=Int J Geriatr Psychiatry |volume=34 |issue=6 |pages=781–789 |date=June 2019 |pmid=30773695 |pmc=6830540 |doi=10.1002/gps.5088 |url=}}</ref><ref name="pmid26360863">{{cite journal |vauthors=O'Sullivan R, Inouye SK, Meagher D |title=Delirium and depression: inter-relationship and clinical overlap in elderly people |journal=Lancet Psychiatry |volume=1 |issue=4 |pages=303–11 |date=September 2014 |pmid=26360863 |pmc=5338740 |doi=10.1016/S2215-0366(14)70281-0 |url=}}</ref><ref name="CharltonKavanau2002">{{cite journal|last1=Charlton|first1=B.G|last2=Kavanau|first2=J.L|title=Delirium and psychotic symptoms – an integrative model|journal=Medical Hypotheses|volume=58|issue=1|year=2002|pages=24–27|issn=03069877|doi=10.1054/mehy.2001.1436}}</ref>


There are several medical definitions of delirium (including those in the [[Diagnostic and Statistical Manual of Mental Disorders|DSM-IV]] and [[ICD|ICD-10]]). However, all include some core features.
{| border="3"
|+ '''The difference between [[delirium]] and similar [[psychiatric]] illness'''
! Attributes !! [[Delirium ]] !![[ Alzheimer]] disease!![[Depression]]!![[Psychotic]] Disorders
|-
! Onset
| Sudden/acute/subacute
| Gradual
|Gradual
|Acute or gradual
|-
! Progression
| Shifts in severity, likely to resolve in days to weeks.
| Worsens over a period of time
|Acute or chronic with acute exacerbation
|Chronic with acute exacerbation
|-
![[ Hallucinations]]
| May be present, mostly [[visual]]
| Mostly absent (exceptions: Lewi body [[dementia]])
| May be present if associated with [[ psychotic]] features
| Present
|-
! [[Delusions]]
| [[Fleeting]]
| Mostly not present
| May be present
| Present
|-
! [[Psychomotar]] activity
| Increased or decreased, may shift from increased to decreased states.
| May or may not change
| Change
| Change
|-
! [[Attention]]
| Poor attention span and impaired short-term [[memory]]
| Progressive worsening short-term [[memory]]. [[Attention]] span is likely to be affected in severe cases
| May be altered
| May be altered
|-
! [[Consciousness]]
| Altered, rapidly shifts
| Mostly intact until severe stages
| Normal
| Normal
|-
! [[Attention]]
| Altered, rapidly shifts
| Mostly intact until severe stages
| May be altered
| May be altered
|-
! [[Orientation]]
| Altered, rapidly shifts
| Mostly intact until severe stages
| Not altered
| Not altered
|-
! [[Speech]]
| Not coherent
| Errors
| Slow
| Normal or pressured
|-
! [[Thought]]
| Disorganized
| Impoverished
| Normal
| Disorganized
|-
! [[Perceptions]]
| Altered, rapidly shifts
| Mostly intact until severe stages
| Normal
| May be altered
|-
! [[EEG]]
| Moderate to severe background slowing
| Normal or mild diffuse slowing
| Normal
| Normal
|-
! [[Reversibility]]
| Mostly
| Very rarely
| Yes
| Rarely
|-
|}<ref>{{Cite web  | last =  | first =  | title = Delirium in elderly adults: diagnosis, prevention and treatment | url = http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3065676/ | publisher =  | date =  | accessdate = }}</ref>


The core features are:
===[[Psychiatric]] Disorders===
* Disturbance of consciousness (that is, reduced clarity of awareness of the environment, with reduced ability to focus, sustain, or shift attention)
*'''[[Psychotic]] disorders''': [[Delirium]] may be distinguished from [[psychosis]], in which [[consciousness]] and cognition may not be impaired (however, there may be overlap, in acute [[psychosis]], especially with [[mania]], is capable of producing [[delirium]]-like states).
* Change in cognition (e.g., problem-solving impairment or memory impairment) or a perceptual disturbance
* [[Delirium]] must be differentiated from following [[psychiatric]] disorders which have [[psychotic]] features.
* Onset of hours to days, and tendency to fluctuate.
:*[[Brief psychotic disorder]]
:*[[Schizophrenia]]
:*[[Schizophreniform disorder]]
:*[[Bipolar Disorder|Bipolar]] and [[depression|depressive disorders with psychotic features]].
* [[Mania]] should be differentiated from hyperactive [[delirium]].
* Previous history of [[bipolar disorder]] is useful in distinguishing [[delirium]] from [[mania]].
*'''Acute [[stress disorder]]''': [[Delirium]] accompanied by [[fear]], [[anxiety]], and [[dissociative]] symptoms must be differentiated from [[acute stress disorder]]s.
*'''[[Malingering]] and [[factitious disorder]]'''.
*'''[[Confusional]] states''': [[Delirium ]] is distinguished by time-course from the [[confusion]] and lack of [[attention]] which result from long term learning disorders and varieties of [[congenital]] [[brain]] dysfunction.
*Delirium is not the same as [[confusion]], although the two syndromes may overlap and be present at the same time.
* However, a confused [[patient]] may not be [[delirious]] (an example would be a stable, demented person who is [[disoriented]] to [[time]] and [[place]]), and a [[delirious]] person may not be [[confused]] (for example, a person in severe [[pain]] may not be able to focus because of the [[pain]], and thus be by definition delirious, but may be completely [[oriented]] and not at all [[confused]]).
*'''Other neurocognitive disorders''': Sometimes [[delirium]] is superimposed on underling [[neurocognitive]] disorders such as [[dementia]].<ref name="pmid26139023">{{cite journal |vauthors=Fong TG, Davis D, Growdon ME, Albuquerque A, Inouye SK |title=The interface between delirium and dementia in elderly adults |journal=Lancet Neurol |volume=14 |issue=8 |pages=823–832 |date=August 2015 |pmid=26139023 |pmc=4535349 |doi=10.1016/S1474-4422(15)00101-5 |url=}}</ref>


Common features also tend to include:
===Dementia===
* Intrusive abnormalities of awareness and [[Affect (psychology)|affect]], such as [[hallucination]]s or inappropriate emotional states.
* [[Delirium]] is distinguished from [[dementia]] ([[chronic organic brain syndrome]]) which describes an "acquired" (non-congenital) and usually irreversible [[cognitive]] and [[psychosocial]] decline in function.
* [[Dementia]] usually results from an identifiable [[degenerative]] [[brain ]] disease (for example [[Alzheimer disease]] or [[Huntington disease]]).
* [[Dementia]] is usually not associated with a change in the level of [[consciousness]], and a diagnosis of [[dementia]] requires a chronic impairment.
* Sundowning: In  [[patients] suffering from [[dementia]] or [[delirium]] which is an impairment in [[behavioral]] patterns in the evening hours.<ref name="pmid28083535">{{cite journal |vauthors=Canevelli M, Valletta M, Trebbastoni A, Sarli G, D'Antonio F, Tariciotti L, de Lena C, Bruno G |title=Sundowning in Dementia: Clinical Relevance, Pathophysiological Determinants, and Therapeutic Approaches |journal=Front Med (Lausanne) |volume=3 |issue= |pages=73 |date=2016 |pmid=28083535 |pmc=5187352 |doi=10.3389/fmed.2016.00073 |url=}}</ref>


== Complete List of Differential Diagnoses ==
===Other Neurological Disorders===
*[[Frontal lobe disorders]] such as [[tumors]] can produce deficits in [[memory]], distorted [[emotional]] responses, impaired [[judgment]].
* Imaging studies and focal [[neurological]] symptoms may be helpful to differentiate from [[delirium]].
*[[Temporal lobe]] disorders may lead to [[memory]] deficits, [[cortical]] deafness, [[visual]] [[agnosia]]. 
* Imaging studies and focal [[neurological]] symptoms may be helpful to differentiate from [[delirium]].
* [[Occipital lobe]] disorders can demonstrate various symptoms such as [[confabulation]], [[cortical blindness]].
* Imaging studies and focal [[neurological]] symptoms may be helpful to differentiate from [[delirium]].
* [[Parietal]] lobe disorders like [[Wernicke's aphasia]] can hinder a patient's ability to follow examiner's instructions which are often misinterpreted as a state of [[confusion]].
* [[Nonconvulsive]] [[epileptic]] episodes should also be considered as a differential diagnosis of [[delirium]].
**[[Delirium]] represents an organically caused decline from a previously [[attained]] level of [[cognitive]] functioning.
 
===Complete List of Differential Diagnoses===
{{col-begin|width=80%}}
{{col-break|width=33%}}
* [[Acidosis]]
* [[Acidosis]]
* After [[hypoxia]]
* After [[hypoxia]]
* [[Alcohol]]/[[drug withdrawal]]
* [[Alcohol]]/[[drug withdrawal]]
* [[Bacterial Meningitis]]
* [[Meningitis|Bacterial Meningitis]]
* [[Cerebral]] [[contusion]]
* [[Cerebral]] [[contusion]]
* [[Cerebral]] [[ischemia]]
* [[Cerebral]] [[ischemia]]
* [[Cerebral]] [[mass]]es
* [[Cerebral]] [[mass]]
* [[Congestive Heart Failure]] ([[CHF]])
* [[Congestive Heart Failure]] ([[CHF]])
* [[Ddx:Dementia|Dementia]]
* [[Ddx:Dementia|Dementia]]
Line 33: Line 149:
* [[HIV]]
* [[HIV]]
* [[Ddx:Hypoglycemia|Hypoglycemia]]
* [[Ddx:Hypoglycemia|Hypoglycemia]]
{{col-break|width=33%}}
* [[Pneumonia]]
* [[Pneumonia]]
* Postoperative and postconcussive states
* [[Trauma|Postoperative and postconcussive states]]
* Psychotic illness
* [[Psychosis|Psychotic illness]],
* [[Rheumatic Fever]]
* [[Rheumatic Fever]]
* [[Septicemia]]
* [[Septicemia]]
* [[Stroke]]
* [[Stroke]]
* [[Ddx:Intracranial Bleeding|Subarachnoid hemorrhage]]
* [[Ddx:Intracranial Bleeding|Subarachnoid hemorrhage]]
* Sundowning
* [[Dementia|Sundowning]]
* [[Thiamine deficiency]]
* [[Thiamine deficiency]]
* [[Thyrotoxicosis]]
* [[Thyrotoxicosis]]
* [[Toxin]]s
* [[Toxin]]
* [[Tuberculosis]]
* [[Tuberculosis]]
* [[Typhoid Fever]]
* [[Typhoid Fever]]
* [[Viral encephalitis]]
* [[Viral encephalitis]]
|}


==References==
==References==

Latest revision as of 08:06, 22 April 2021

Delirium Microchapters

Home

Patient Information

Overview

Historical Perspective

Classification

Pathophysiology

Causes

Differentiating Delirium from other Diseases

Epidemiology and Demographics

Risk Factors

Natural History, Complications and Prognosis

Diagnosis

Diagnostic Criteria

History and Symptoms

Physical Examination

Laboratory Findings

CT

MRI

Other Diagnostic Studies

Treatment

Medical Therapy

Primary Prevention

Secondary Prevention

Cost-Effectiveness of Therapy

Future or Investigational Therapies

Case #1

Delirium On the Web

Most recent articles

Most cited articles

Review articles

CME Programs

Powerpoint slides

Images

American Roentgen Ray Society Images of Delirium

All Images
X-rays
Ultrasound
CT Images
MRI

Ongoing Trials at Clinical Trials.gov

US National Guidelines Clearinghouse

NICE Guidance

FDA on Delirium

CDC on Delirium

Delirium in the news

Blogs on Delirium

Directions to Hospitals Treating Delirium

Risk calculators and risk factors for Delirium

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Pratik Bahekar, MBBS [2]; Vishal Khurana, M.B.B.S., M.D. [3]

Overview

Delirium is differentiated from other causes cognitive dysfunction such as psychiatric Disorders, dementia. Unlike dementia, the course of delirium is reversible with fluctuation in level of consciousness.

Differential Diagnosis

The difference between delirium and similar psychiatric illness
Attributes Delirium Alzheimer disease Depression Psychotic Disorders
Onset Sudden/acute/subacute Gradual Gradual Acute or gradual
Progression Shifts in severity, likely to resolve in days to weeks. Worsens over a period of time Acute or chronic with acute exacerbation Chronic with acute exacerbation
Hallucinations May be present, mostly visual Mostly absent (exceptions: Lewi body dementia) May be present if associated with psychotic features Present
Delusions Fleeting Mostly not present May be present Present
Psychomotar activity Increased or decreased, may shift from increased to decreased states. May or may not change Change Change
Attention Poor attention span and impaired short-term memory Progressive worsening short-term memory. Attention span is likely to be affected in severe cases May be altered May be altered
Consciousness Altered, rapidly shifts Mostly intact until severe stages Normal Normal
Attention Altered, rapidly shifts Mostly intact until severe stages May be altered May be altered
Orientation Altered, rapidly shifts Mostly intact until severe stages Not altered Not altered
Speech Not coherent Errors Slow Normal or pressured
Thought Disorganized Impoverished Normal Disorganized
Perceptions Altered, rapidly shifts Mostly intact until severe stages Normal May be altered
EEG Moderate to severe background slowing Normal or mild diffuse slowing Normal Normal
Reversibility Mostly Very rarely Yes Rarely

[4]

Psychiatric Disorders

Dementia

Other Neurological Disorders

Complete List of Differential Diagnoses

References

  1. ↑ Fong TG, Vasunilashorn SM, Libermann T, Marcantonio ER, Inouye SK (June 2019). "Delirium and Alzheimer disease: A proposed model for shared pathophysiology". Int J Geriatr Psychiatry. 34 (6): 781–789. doi:10.1002/gps.5088. PMC 6830540 Check |pmc= value (help). PMID 30773695.
  2. ↑ O'Sullivan R, Inouye SK, Meagher D (September 2014). "Delirium and depression: inter-relationship and clinical overlap in elderly people". Lancet Psychiatry. 1 (4): 303–11. doi:10.1016/S2215-0366(14)70281-0. PMC 5338740. PMID 26360863.
  3. ↑ Charlton, B.G; Kavanau, J.L (2002). "Delirium and psychotic symptoms – an integrative model". Medical Hypotheses. 58 (1): 24–27. doi:10.1054/mehy.2001.1436. ISSN 0306-9877.
  4. ↑ "Delirium in elderly adults: diagnosis, prevention and treatment".
  5. ↑ Fong TG, Davis D, Growdon ME, Albuquerque A, Inouye SK (August 2015). "The interface between delirium and dementia in elderly adults". Lancet Neurol. 14 (8): 823–832. doi:10.1016/S1474-4422(15)00101-5. PMC 4535349. PMID 26139023.
  6. ↑ Canevelli M, Valletta M, Trebbastoni A, Sarli G, D'Antonio F, Tariciotti L, de Lena C, Bruno G (2016). "Sundowning in Dementia: Clinical Relevance, Pathophysiological Determinants, and Therapeutic Approaches". Front Med (Lausanne). 3: 73. doi:10.3389/fmed.2016.00073. PMC 5187352. PMID 28083535.

Template:WH Template:WS

Retrieved from "https://www.wikidoc.org/index.php?title=Delirium_differential_diagnosis&oldid=1698065"