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: Sara Zand, M.D.[2] Pratik Bahekar, MBBS [3]; Vishal Khurana, M.B.B.S., M.D. [4]
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.
Complications and Prognosis
- The duration of delirium may vary from days to months.[1]
- After remission , delirium may increase the risk of functional decline, cognitive dysfunction, and institutional placement, and with higher mortality.[2]
- Delirium in the elderly, can cause many complications, which may include pneumonia and decubitus ulcers, prolonging hospital stays.
- 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.
- After one episode of delirium, the mortality rate was 24%-76% within one year.
- Delirium was associated with longer postoperative recovery periods, longer hospital stays, and long-term disability after orthopedic surgery.[3]
- Common complications associated with delirium include increased mortality, cognitive impairment, longer durations of mechanical ventilation, longer lengths of stay in the ICU.[4]
- Prognosis is dependent on the severity of delirium, and the 1 year mortality rate of patients with delirium is approximately 10%-26%.[5]
References
- ↑ Rudberg, Mark A; Pompei, Peter; Foreman, Marquis D.; Ross, Ruth E.; Cassel, Christine K. (1997). "The natural history of delirium in older hospitalized patients: a syndrome of heterogeneity". Age and Ageing. 26 (3): 169–174. doi:10.1093/ageing/26.3.169. ISSN 0002-0729.
- ↑ McNicoll, Lynn; Pisani, Margaret A.; Zhang, Ying; Ely, E. Wesley; Siegel, Mark D.; Inouye, Sharon K. (2003). "Delirium in the Intensive Care Unit: Occurrence and Clinical Course in Older Patients". Journal of the American Geriatrics Society. 51 (5): 591–598. doi:10.1034/j.1600-0579.2003.00201.x. ISSN 0002-8614.
- ↑ "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.