Delirium natural history, complications and prognosis

Delirium Microchapters
Home
Patient Information
Overview
Historical Perspective
Classification
Pathophysiology
Causes
Differentiating Delirium from other Diseases
Epidemiology and Demographics
Risk Factors
Natural History, Complications and Prognosis
Diagnosis
Diagnostic Criteria
History and Symptoms
Physical Examination
Laboratory Findings
CT
MRI
Other Diagnostic Studies
Treatment
Medical Therapy
Primary Prevention
Secondary Prevention
Cost-Effectiveness of Therapy
Future or Investigational Therapies
Case #1
Delirium On the Web
Most recent articles
Most cited articles
Review articles
CME Programs
Powerpoint slides
Images
American Roentgen Ray Society Images of Delirium All Images X-rays Ultrasound CT Images MRI
Ongoing Trials at Clinical Trials.gov
US National Guidelines Clearinghouse
NICE Guidance
FDA on Delirium
CDC on Delirium
Delirium in the news
Blogs on Delirium
Directions to Hospitals Treating Delirium
Risk calculators and risk factors for 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]; 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 and natural 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 as fluid and tissue concentrations of the substance decrease after reduction of 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 and may not have an onset of withdrawal symptoms for days or weeks after use of the substance is discontinued. Substance withdrawal delirium may continue for only 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.