Delirium natural history, complications and prognosis

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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]; Pratik Bahekar, MBBS [3]

Overview

History, complication of delirium and prognosis depends for many factors such as, etiology, risk factors, and co-morbid illness.

History

The duration of delirium is typically affected by the underlying cause. If caused by a fever, the delirious state often subsides as the severity of the fever subsides.

• Ranges from less than a week to more than 2 months
• Most of the times symptoms resolve by 10 to 12 days
• Up to 15% of patients, typically elderly, delirium may last for a month and beyond.

Delirium associated with substance withdrawal develops when concentrations of the substance in fluid and tissue decrease after sustained, high-dose use of certain substances. Substance withdrawal delirium can also occur after the reduction of lower doses in patients having poor clearance, experiencing drug interactions, or taking combinations of drugs. The duration of the delirium usually varies with the half-life of the substance involved. Longer-acting substances usually are associated with less severe but more protracted withdrawal also they may not have an onset of withdrawal symptoms for days to weeks after use of the substance is discontinued. Substance withdrawal delirium may continue for a few hours or may persist for as long as 2-4 weeks.

Complications and Prognosis

• Majority of patients have complete recovery
• If untreated delirium may progress to stupor, coma, seizures, or death
• Delirium in AIDS patients has a poorer prognosis, 27% tends to have complete recovery of cognitive faculties, this may be because of underlying AIDS dementia
• Delirium in an elderly, can cause many complications, which may include pneumonia and decubitus ulcers, prolonging hospital stays.
• Elderly:

1. Only 4% to 40% may have complete recovery
2. Persistent cognitive deficits are common while recovering from delirium, may be related previously unknown aliments
3. 22%–76% chance of dying during hospitalization if delirium is developed during respective hospital stay and a very high death rate during the months following discharge.

• Up to 25% of patients with delirium die within 6 months and that their mortality rate in the 3 months after diagnosis is 14 times as high as the mortality rate for patients with affective disorders.
• If delirium develops after orthopedic surgery, risk for postoperative complications increases: longer postoperative recuperation periods, longer hospital stays, and long-term disability.