Delirium pathophysiology: Difference between revisions
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==Overview== | ==Overview== | ||
==Causation== | |||
Delirium, like mental confusion, is a very general and nonspecific symptom of organ dysfunction, where the organ in question is the brain. In addition to many organic causes relating to a structural defect or a metabolic problem in the brain (analogous to hardware problems in a computer), there are also some psychiatric causes, which may also include a component of mental or emotional stress, mental disease, or other "programming" problems (analogous to software problems in a computer). | |||
Too many to list by specific pathology, general categories of cause of delirium include: | |||
===Gross structural brain disorders=== | |||
* [[Head trauma]] (i.e., concussion, traumatic bleeding, penetrating injury, etc.) | |||
* Gross structural damage from brain disease (stroke, spontaneous bleeding, tumor, etc.) | |||
===Neurological disorders=== | |||
* Various [[neurological disorders]] | |||
* Lack of [[sleep]] | |||
===Circulatory=== | |||
* [[Idiopathic intracranial hypertension|Intracranial Hypertension]] | |||
===Lack of essential metabolic fuels, nutrients, etc.=== | |||
* [[Hypoxia (medical)|Hypoxia]], | |||
* [[Hypoglycemia]] | |||
* [[Electrolyte]] imbalance (dehydration, water intoxication) | |||
===Toxication===<!-- This section is linked from [[The Verve]] --> | |||
* [[Intoxication]] various drugs, alcohol, anesthetics | |||
* Sudden withdrawal of chronic drug use ("de-tox") in a person with certain types of [[drug addiction]] (e.g. alcohol, see [[delirium tremens]], and many other sedating drugs) | |||
* [[Poisons]] (including carbon monoxide and metabolic blockade) | |||
* [[Medication]]s including psychotropic medications | |||
===Mental illness per se is not a cause, as a matter of definition=== | |||
Some mental illnesses, such as mania, or some types of acute psychosis, may cause a rapidly fluctuating impairment of cognitive function and ability to focus. However, they are not technically causes of delirium, since any fluctuating cognitive symptoms that occur as a result of these mental disorders are considered ''by definition'' to be due to the mental disorder itself, and to be a part of it. Thus, ''physical'' disorders can be said to produce delirium as a mental side-effect or symptom; however primary ''mental'' disorders which produce the symptom cannot be put into this category, once identified. However, such symptoms may be impossible to distinguish clinically from delirium resulting from physical disorders, if a diagnosis of an underlying mental disorder has yet to be made. | |||
== History and Symptoms == | |||
* Thorough history including: | |||
*:* Incoherent speech | |||
*:* Memory difficulties | |||
*:* Disorientation | |||
*:* Level of attention | |||
*:* Conversations with family and/or caregivers of patient | |||
* Performance of abbreviated mental exam | |||
=== Risk Factors === | |||
* Age | |||
* Cognitive impairments | |||
* Psychiatric conditions | |||
* Severe chronic medical illness | |||
==References== | ==References== | ||
Revision as of 04:25, 12 February 2014
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Delirium Microchapters |
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Delirium On the Web |
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American Roentgen Ray Society Images of Delirium |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Vishal Khurana, M.B.B.S., M.D. [2]
Overview
Causation
Delirium, like mental confusion, is a very general and nonspecific symptom of organ dysfunction, where the organ in question is the brain. In addition to many organic causes relating to a structural defect or a metabolic problem in the brain (analogous to hardware problems in a computer), there are also some psychiatric causes, which may also include a component of mental or emotional stress, mental disease, or other "programming" problems (analogous to software problems in a computer).
Too many to list by specific pathology, general categories of cause of delirium include:
Gross structural brain disorders
- Head trauma (i.e., concussion, traumatic bleeding, penetrating injury, etc.)
- Gross structural damage from brain disease (stroke, spontaneous bleeding, tumor, etc.)
Neurological disorders
- Various neurological disorders
- Lack of sleep
Circulatory
Lack of essential metabolic fuels, nutrients, etc.
- Hypoxia,
- Hypoglycemia
- Electrolyte imbalance (dehydration, water intoxication)
Toxication
- Intoxication various drugs, alcohol, anesthetics
- Sudden withdrawal of chronic drug use ("de-tox") in a person with certain types of drug addiction (e.g. alcohol, see delirium tremens, and many other sedating drugs)
- Poisons (including carbon monoxide and metabolic blockade)
- Medications including psychotropic medications
Mental illness per se is not a cause, as a matter of definition
Some mental illnesses, such as mania, or some types of acute psychosis, may cause a rapidly fluctuating impairment of cognitive function and ability to focus. However, they are not technically causes of delirium, since any fluctuating cognitive symptoms that occur as a result of these mental disorders are considered by definition to be due to the mental disorder itself, and to be a part of it. Thus, physical disorders can be said to produce delirium as a mental side-effect or symptom; however primary mental disorders which produce the symptom cannot be put into this category, once identified. However, such symptoms may be impossible to distinguish clinically from delirium resulting from physical disorders, if a diagnosis of an underlying mental disorder has yet to be made.
History and Symptoms
- Thorough history including:
- Incoherent speech
- Memory difficulties
- Disorientation
- Level of attention
- Conversations with family and/or caregivers of patient
- Performance of abbreviated mental exam
Risk Factors
- Age
- Cognitive impairments
- Psychiatric conditions
- Severe chronic medical illness