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: Pratik Bahekar, MBBS [2]; Vishal Khurana, M.B.B.S., M.D. [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 time 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 the elderly, can cause many complications, which may include pneumonia and decubitus ulcers, prolonging hospital stays.
- Only 4% to 40% may have a complete recovery.
- Persistent cognitive deficits are common while recovering from delirium, may be related to previously unknown ailments.
- 22%–76% chance of dying during hospitalization if delirium is developed during the 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.
- Delirium was associated with include longer postoperative recovery periods, longer hospital stays, and long-term disability after orthopedic surgery.[1]
- Common complications associated with delirium include increased mortality, cognitive impairment, longer durations of mechanical ventilation, longer lengths of stay in the ICU.[2]
- Prognosis is varied depending on the severity of delirium, and the 1 year mortality rate of patients with delirium is approximately 10%-26%.[3]
The majority of patients with [disease name] remain asymptomatic for [duration/years].
- Early clinical features include [manifestation 1], [manifestation 2], and [manifestation 3].
- If left untreated, [#%] of patients with [disease name] may progress to develop [manifestation 1], [manifestation 2], and [manifestation 3].
- Common complications of [disease name] include [complication 1], [complication 2], and [complication 3].
- Prognosis is generally [excellent/good/poor], and the [1/5/10year mortality/survival rate] of patients with [disease name] is approximately [#%].
References
- ↑ "Practice guideline for the treatment of pati... [Am J Psychiatry. 1999] - PubMed - NCBI".
- ↑ Salluh, J. I. F.; Wang, H.; Schneider, E. B.; Nagaraja, N.; Yenokyan, G.; Damluji, A.; Serafim, R. B.; Stevens, R. D. (2015). "Outcome of delirium in critically ill patients: systematic review and meta-analysis". BMJ. 350 (may19 3): h2538–h2538. doi:10.1136/bmj.h2538. ISSN 1756-1833.
- ↑ McCusker J, Cole M, Abrahamowicz M, Primeau F, Belzile E (February 2002). "Delirium predicts 12-month mortality". Arch Intern Med. 162 (4): 457–63. doi:10.1001/archinte.162.4.457. PMID 11863480.