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{{Delirium}}
{{Delirium}}
{{CMG}}; {{AE}} [[User:Vishal Khurana|Vishal Khurana]], M.B.B.S., M.D. [mailto:vishdoc24@gmail.com] ; {{PB}}
{{CMG}}; {{AE}} {{Sara.Zand}} {{PB}}; [[User:Vishal Khurana|Vishal Khurana]], M.B.B.S., M.D. [mailto:vishdoc24@gmail.com]


==Overview==
==Overview==
Delirium is classified on the basis of etiology, duration and severity.
[[Delirium]] is classified on the basis of etiology, duration, and severity. Hyperactive [[delirium]] is defined as increased [[psychomotor]] activity, which may occur with increased [[mood]] [[lability]], [[agitation]], non cooperative [[attitude]] towards [[medical]] treatment. Hypoactive [[delirium]] is explained by a hypoactive level of [[psychomotor]] activity, which may exist along with increased [[lethargy]] or [[stupor]], [[inattentiveness]] and [[motor]] slowness and is much more common among [[ICU]] admitted [[patients]] with severe disease.
 
==Types of Delirium==
==Types of Delirium==
DSM V specifies delirium on various virtues,
[[Delirium]] may be classified into the following:
 
{| style="border: 2px solid #4479BA; align="left"
! style="width: 200px; background: #4479BA;" | {{fontcolor|#FFF|Diagnostic and Statistical Manual (DSM)-5}}
! style="width: 300px; background: #4479BA;" | {{fontcolor|#FFF|World Health Organization's International Classification of Diseases (10th revision)}}
! style="width: 400px; background: #4479BA;" | {{fontcolor|#FFF|ICD-10}}
|-
| style="padding: 0 5px; background: #F5F5F5; text-align: left;" |
* Disturbance in [[attention]] and [[awareness]] (reduced ability to direct, focus, shift [[attention]] and reduced [[orientation]] to [[envinment]])
*Initiation of disturbance over a short period of time during several hours or days  with fluctuation  in severity over a day
*Disturbance in [[cognition]] ([[memory deficit]], [[disorientation]], [[language]], [[visuospatial]] ability, [[perception]]
* Disturbance other than evolving [[neurocognitive]] disorder
* Disturbance due to medical [[condition]], [[substance intoxication]], or withdrawal, [[toxin]] [[exposure]]
| style="padding: 0 5px; background: #F5F5F5; text-align: left;" |
*Disturbance in [[cognition]]
*Impairment of [[immediate recall]] and [[recent memory]]
*[[Disorientation]] to [[time]], [[place]], [[person]]
| style="padding: 0 5px; background: #F5F5F5; text-align: left;" |
*Disturbance in [[sleep wake]] cycle
* [[Psychomotor disturbances]]
* [[Emotional disturbances]]
* Upper limit [[time]]: 6 months
|-
|}
{{clear}}
 
 
{| border="1" cellpadding="5" cellspacing="0"
|-
!Classification based on || Types
|-
| rowspan="4"| Etiology
| colspan="2" align="Left"| [[Substance]] [[intoxication]] [[delirium]]
|-
| colspan="2" align="Left"| [[Substance]] [[withdrawal]] [[delirium]]
|-
| colspan="2" align="Left"| [[Delirium]] caused by another [[medical]] [[condition]]
|-
| colspan="2" align="Left"| [[Delirium]] caused by multiple [[etiologies]]
|-
| rowspan="2"| Duration
| colspan="2" align="Left"| [[Acute]]
|-
| colspan="2" align="Left"| [[Persistent]]
|-
| rowspan="3"| Severity
| colspan="2" align="Left"| [[Hyperactive]]
|-
| colspan="2" align="Left"| [[Hypoactive]]
|-
| colspan="2" align="Left"| Mixed level of activity
|}
 
===Based on Duration===
* '''Acute''': When [[delirium]] lasts for a few hours to days.
* '''Persistent''': When [[delirium]] lasts for weeks or months.
 
===Based on Severity===
* '''Hyperactive''': An increased [[psychomotor]] activity, which may co-occur with, increased [[mood]] [[lability]], [[agitation]], and/or non cooperative [[attitude]] towards medical treatment.
* '''Hypoactive''': A hypoactive level of psychomotor activity, which may exist along with increased [[sluggishness]], [[lethargy]] or [[stupor]], [[inattentiveness]] and [[motor]] slowness and is much more common among [[ICU]] admitted [[patients]] with severe [[disease]].<ref name="KrewulakStelfox2018">{{cite journal|last1=Krewulak|first1=Karla D.|last2=Stelfox|first2=Henry T.|last3=Leigh|first3=Jeanna Parsons|last4=Ely|first4=E. Wesley|last5=Fiest|first5=Kirsten M.|title=Incidence and Prevalence of Delirium Subtypes in an Adult ICU|journal=Critical Care Medicine|volume=46|issue=12|year=2018|pages=2029–2035|issn=0090-3493|doi=10.1097/CCM.0000000000003402}}</ref>
* '''Mixed level of activity''': A normal level of [[psychomotor]] activity, individuals with rapidly fluctuating activity are also included in this category.<ref name="Inouye-2013">{{Cite journal  | last1 = Inouye | first1 = SK. | last2 = Westendorp | first2 = RG. | last3 = Saczynski | first3 = JS. | title = Delirium in elderly people. | journal = Lancet | volume =  | issue =  | pages =  | month = Aug | year = 2013 | doi = 10.1016/S0140-6736(13)60688-1 | PMID = 23992774 }}</ref>


Based on etiology:
Some authors have described a fourth type of delirium called as subsyndromal [[delirium]], which is an incomplete form of [[delirium]].<ref name="Young-2007">{{Cite journal | last1 = Young | first1 = J. | last2 = Inouye | first2 = SK. | title = Delirium in older people. | journal = BMJ | volume = 334 | issue = 7598 | pages = 842-6 | month = Apr | year = 2007 | doi = 10.1136/bmj.39169.706574.AD | PMID = 17446616 }}</ref>
* '''Substance intoxication delirium''': diagnosis of substance intoxication delirium is made rather than substance intoxication, when the symptoms in Criteria A and C predominate and are severe enough to require clinical attention.
* '''Substance withdrawal delirium''': diagnosis of substance withdrawal delirium is made rather than substance withdrawal, when the symptoms in Criteria A and C predominate and are severe enough to require clinical attention.
* '''Delirium caused by another medical condition''': When delirium is caused by another medical condition.
* '''Delirium caused by multiple etiologies''': Delirium is a consequence of multiple causes e.g. medical condition plus substance intoxication or side effect of medications.
Based on duration:
* '''Acute''': Duration is restricted to a few hours to days.
* '''Persistent''': when delirium lasts for weeks or months.
Based on severity:
* '''Hyperactive''': An increased psychomotor activity which may co-occur with increased mood lability, agitation, and/or non cooperative attitude towards medical treatment.
* '''Hypoactive''': A hypoactive level of psychomotor activity which may exist along with increased sluggishness, lethargy or stupor.
* '''Mixed level of activity''': A normal level of psychomotor activity, individuals with rapidly fluctuating activity are also included in this category.<ref>{{Cite web  | last =  | first =  | title = http://www.dsm5.org/Pages/Default.aspx | url = http://www.dsm5.org/Pages/Default.aspx | publisher =  | date =  | accessdate = 16 February 2014 }}</ref><ref name="www.ncbi.nlm.nih.gov">{{Cite web  | last =  | first =  | title = Delirium in elderly people. [Lancet. 2013] - PubMed - NCBI | url = http://www.ncbi.nlm.nih.gov/pubmed/23992774 | publisher =  | date =  | accessdate =}}</ref>
: <font color="#777777"></font>
Some authors have described fourth type of delirium, called as '''Subsyndromal delirium''' (an incomplete form of delirium).<ref name="www.bmj.com">{{Cite web | last = | first = | title = Delirium in older people | BMJ | url =http://www.bmj.com/content/334/7598/842 | publisher = | date = | accessdate =}}</ref>


==References==
==References==

Latest revision as of 08:23, 22 April 2021

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Sara Zand, M.D.[2] Pratik Bahekar, MBBS [3]; Vishal Khurana, M.B.B.S., M.D. [4]

Overview

Delirium is classified on the basis of etiology, duration, and severity. Hyperactive delirium is defined as increased psychomotor activity, which may occur with increased mood lability, agitation, non cooperative attitude towards medical treatment. Hypoactive delirium is explained by a hypoactive level of psychomotor activity, which may exist along with increased lethargy or stupor, inattentiveness and motor slowness and is much more common among ICU admitted patients with severe disease.

Types of Delirium

Delirium may be classified into the following:

Diagnostic and Statistical Manual (DSM)-5 World Health Organization's International Classification of Diseases (10th revision) ICD-10


Classification based on Types
Etiology Substance intoxication delirium
Substance withdrawal delirium
Delirium caused by another medical condition
Delirium caused by multiple etiologies
Duration Acute
Persistent
Severity Hyperactive
Hypoactive
Mixed level of activity

Based on Duration

  • Acute: When delirium lasts for a few hours to days.
  • Persistent: When delirium lasts for weeks or months.

Based on Severity

Some authors have described a fourth type of delirium called as subsyndromal delirium, which is an incomplete form of delirium.[3]

References

  1. ↑ Krewulak, Karla D.; Stelfox, Henry T.; Leigh, Jeanna Parsons; Ely, E. Wesley; Fiest, Kirsten M. (2018). "Incidence and Prevalence of Delirium Subtypes in an Adult ICU". Critical Care Medicine. 46 (12): 2029–2035. doi:10.1097/CCM.0000000000003402. ISSN 0090-3493.
  2. ↑ Inouye, SK.; Westendorp, RG.; Saczynski, JS. (2013). "Delirium in elderly people". Lancet. doi:10.1016/S0140-6736(13)60688-1. PMID 23992774. Unknown parameter |month= ignored (help)
  3. ↑ Young, J.; Inouye, SK. (2007). "Delirium in older people". BMJ. 334 (7598): 842–6. doi:10.1136/bmj.39169.706574.AD. PMID 17446616. Unknown parameter |month= ignored (help)

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