FACTS THAT YOU NEED TO KNOW ABOUT DELIRIUM

Introduction

•Definition : Disturbance of consciousness and a change in cognition that develop over a short time.

•It is a syndrome, not a disease.

•Has many causes.

•Classically, delirium has a sudden onset (hours or days), a brief fluctuating course, and a rapid improvement when the causative factors is identified and eliminated.

Epidemiology 

•Prevalence – 0.4% age >18, 1.1% age >55 

•10-30% of medically ill patients who are hospitalized. 

•30% of patients in surgical and cardiac ICU. 

•30-40% of patients with acquired immune deficiency syndrome who are hospitalize. 

•80% of terminally ill patients. 

Risk Factor

•Advanced age (30-40% hospitalize patients age > 65 years old) 

•Nursing home residents (60% age >75 years old) 

•Other predisposing factors - preexisting brain damage (eg: cerebrovascular disease, tumor), history of delirium, alcohol dependence, diabetes, cancer and malnutrition. 

•Male 

Etiology

Major causes: 

•central nervous system disease (eg: epilepsy) 

•systemic disease (eg: cardiac failure) 

•Intoxication/withdrawal from pharmacological or toxic agents 

*clinicians should assume that any drug that a patient has taken may be the cause of delirium  

 Clinical Features

 

Diagnosis

1.Delirium due to a general medical condition 

2.Substance intoxication delirium 

3.Substance withdrawal delirium 

4.Delirium due to multiple etiologies 

5.Delirium not otherwise specified 

Course and Prognosis

•Symptoms usually persist as long as the causally relevant factors are present 

•Generally, delirium lasts less than a week 

•Symptoms usually recede over a 3 to 7 day period, after removal of causative factors 

•Some symptoms may take up to 2 weeks to resolve 

•The occurrence of delirium is associated with a high mortality rate in the ensuing year 

•Periods of delirium are sometimes followed by depression or PTSD

 Treatment

•Primary goal: treat underlying cause 

•Physical support to prevent accidents 

•Pharmacotherapy 

    i.Psychosis 

      •Haloperidol 2 to 6 mg IM 

      •2nd generation anti-psychotics 

  ii.Insomnia 

      •BDZ with short/intermediate half-lives (e.g lorazepam 1 to 2 mg at bedtime) BDZ with long half-lives should be avoided unless as part of treatment for underlying disorder