Delirium overview
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Delirium Microchapters |
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Diagnosis |
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Treatment |
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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], Pratik Bahekar, MBBS [3]
Overview
Delirium is an acute and relatively sudden (developing over hours to days) decline in attention-focus, perception, and cognition. It is not synonymous with drowsiness, and may occur without it. It is commonly associated with a disturbance of consciousness (e.g., reduced clarity of awareness of the environment). The change in cognition (memory deficit, disorientation, language disturbance) or the development of a perceptual disturbance, must be one that is not better accounted for by a preexisting, established, or evolving dementia. Usually the rapidly fluctuating time course of delirium is used to help in the latter distinction.
Delirium can easily be confused with a number of psychiatric disorders because many of the signs and symptoms are conditions present in dementia, depression, and psychosis. Delirium is probably the single most common acute disorder affecting adults in general hospitals.
Delirium itself is not a disease, but rather a clinical syndrome (a set of symptoms), which result from an underlying disease or new problem with mentation. Distressing symptoms of delirium are sometimes treated with antipsychotic, preferably those with minimal anticholinergic activity, such as haloperidol or risperidone, or else with benzodiazepine, which decrease the anxiety felt by a person who may also be disoriented, and has difficulty completing tasks. However, since these drug treatments do not address the underlying cause of delirium, and may mask changes in delirium which themselves may be helpful in assessing the patient's underlying changes in health, their use is difficult. Because delirium is a mere symptom of another problem which may be very subtle, the wisdom of treatment of the delirious patient with drugs must overcome natural skepticism, and requires a high degree of skill.