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Delirium: Difference between revisions
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Delirium is | <section begin="A&IC" />'''Delirium''' is an acute state of confusion or otherwise disorder mental state caused by somatic (non-psychiatric) illness. It is characterised by lack of the attention and awareness of the environment, and disordered stream of thought. Patients are usually disorientated, confused, have amnesia, are agitated, and have [[Hallucination|hallucinations]] (most commonly visual). It usually worsens at night, and develops over a short period of time. The patient may be hypoactive or hyperactive. | ||
Delirium mostly affects elderly (> 65 years), due to their reduced [[physiological reserves]]. It's a very common condition, affecting almost 30% of elderly patients at some point during hospitalisation; in addition to this, it's probably underdiagnosed. | Delirium mostly affects elderly (> 65 years), due to their reduced [[physiological reserves]]. It's a very common condition, affecting almost 30% of elderly patients at some point during hospitalisation; in addition to this, it's probably underdiagnosed. It’s clinically relevant because it increases mortality, prolongs the hospital stay, and increases reintubation rate. It usually occurs during acute illness and is therefore common in the hospital, especially the ICU. It’s especially common in the ICU because many of the patients are elderly and because there is a lot happening at night in the ICU, so sleep withdrawal is common. | ||
It's one of the ''neurocognitive'' or ''organic mental disorders'', disorders characterising reduced brain function due to non-psychiatric illness. | It's one of the ''neurocognitive'' or ''[[organic mental disorders]]'', disorders characterising reduced brain function due to non-psychiatric illness. | ||
== Etiology == | == Etiology == | ||
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== Diagnosis and evaluation == | == Diagnosis and evaluation == | ||
The diagnosis is clinical, and should be suspected in all elderly with an altered mental status. Determining and treating the underlying cause is essential. Labs, medication review, and medical history may provide clues to the etiology. | The diagnosis is clinical, and should be suspected in all elderly with an altered mental status. Determining and treating the underlying cause is essential. Labs, medication review, and medical history may provide clues to the etiology. | ||
=== Screening === | |||
The patients can be screened with the intensive care delirium screening checklist (ICDSC) or confusion assessment method in the ICU (CAM-ICU). | |||
== Management == | == Management == | ||
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In some cases of hyperactive delirium, patient behaviour may interfere with patient care or safety. Physical restraint should be avoided if possible, but may sometimes be necessary. | In some cases of hyperactive delirium, patient behaviour may interfere with patient care or safety. Physical restraint should be avoided if possible, but may sometimes be necessary. | ||
If all else fails, low-dose antipsychotics can be used to treat severe agitation in delirium. Haloperidol is often used. It can be administered intramuscularly if necessary. Benzodiazepines should be avoided as they may worsen the condition. | If all else fails, low-dose antipsychotics can be used to treat severe agitation in delirium. Haloperidol is often used. It can be administered intramuscularly if necessary. Benzodiazepines should be avoided as they may worsen the condition.<section end="A&IC" /> | ||
[[Category:Intensive care]] | |||
[[Category:Psychiatry]] | [[Category:Psychiatry]] | ||