Delirium: Difference between revisions
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The strongest risk factors for developing delirium are [[ | The strongest risk factors for developing delirium are impaired [[cognition]] and [[psychotropic drug]] use.<ref name="pmid17038078">{{cite journal |author=Dasgupta M, Dumbrell AC |title=Preoperative risk assessment for delirium after noncardiac surgery: a systematic review |journal=J Am Geriatr Soc |volume=54 |issue=10 |pages=1578–89 |year=2006 |month=October |pmid=17038078 |doi=10.1111/j.1532-5415.2006.00893.x |url=http://www3.interscience.wiley.com/resolve/openurl?genre=article&sid=nlm:pubmed&issn=0002-8614&date=2006&volume=54&issue=10&spage=1578 |issn=}}</ref> | ||
A [[clinical prediction rule]] for hospitalized [[geriatrics|geriatric]] patients assigned one point to each of the following:<ref name="pmid8357112">{{cite journal |author=Inouye SK, Viscoli CM, Horwitz RI, Hurst LD, Tinetti ME |title=A predictive model for delirium in hospitalized elderly medical patients based on admission characteristics |journal=Ann. Intern. Med. |volume=119 |issue=6 |pages=474–81 |year=1993 |month=September |pmid=8357112 |doi= |url=http://www.annals.org/cgi/pmidlookup?view=long&pmid=8357112 |issn=}}</ref> | A [[clinical prediction rule]] for hospitalized [[geriatrics|geriatric]] patients assigned one point to each of the following:<ref name="pmid8357112">{{cite journal |author=Inouye SK, Viscoli CM, Horwitz RI, Hurst LD, Tinetti ME |title=A predictive model for delirium in hospitalized elderly medical patients based on admission characteristics |journal=Ann. Intern. Med. |volume=119 |issue=6 |pages=474–81 |year=1993 |month=September |pmid=8357112 |doi= |url=http://www.annals.org/cgi/pmidlookup?view=long&pmid=8357112 |issn=}}</ref> | ||
Revision as of 08:48, 8 January 2009
In medicine, delirium is a "disorder characterized by confusion; inattentiveness; disorientation; illusions; hallucinations; agitation; and in some instances autonomic nervous system overactivity )."[1][2]
According to the Diagnostic and Statistical Manual of Mental Disorders, delirium is "reduced ability to think or concentrate, restlessness, anxiety, irritability, drowsiness, hypersensitivity to stimuli, nightmares."[3]
Subsyndromal delirium
Subsyndromal delirium may cause morbidity among hospitalized individuals.[3]
Diagnosis
The confusion assessment method (CAM), which is an algorithm with four criteria based on the Diagnostic and Statistical Manual of Mental Disorders can help diagnose when the first two criteria are present and either the third or fourth criteria is present:[4]
- acute onset and fluctuating course
- inattention
- disorganized thinking
- altered level of consciousness
The Mini-mental state examination (MMSE) can also help and can be found in the appendix of its original publication.[5]
Specific disorders such as substance withdrawal syndrome, intoxication, Wernicke encephalopathy, and osmotic demyelination syndrome (central pontine myelinolysis) should be excluded.
Treatment
Antipsychotic agents can improve deliriuim.[6]
Benzodiazepams may worsen delirium.[7]
Cholinesterase inhibitors like donepezil do not clearly help, but they have not been well studied.[8]
Prevention
Who is at risk?
The strongest risk factors for developing delirium are impaired cognition and psychotropic drug use.[9]
A clinical prediction rule for hospitalized geriatric patients assigned one point to each of the following:[10]
- vision impairment
- severe illness
- cognitive impairment
- high blood urea nitrogen/creatinine ratio
The rates of delirium were:[10] 0-1 points 9% 1-2 points 23% 3-4 points 83%
Interventions
"Proactive geriatric consultation may reduce delirium incidence and severity...prophylactic low dose haloperidol may reduce severity and duration of delirium episodes according to a systematic review by the Cochrane Collaboration."[11]
References
- ↑ Anonymous (2024), Delirium (English). Medical Subject Headings. U.S. National Library of Medicine.
- ↑ Breitbart, William; Yesne Alici (2008-12-24). "Agitation and Delirium at the End of Life: "We Couldn't Manage Him"". JAMA 300 (24): 2898-2910. DOI:10.1001/jama.2008.885. Retrieved on 2009-01-07. Research Blogging.
- ↑ 3.0 3.1 Cole M, McCusker J, Dendukuri N, Han L (June 2003). "The prognostic significance of subsyndromal delirium in elderly medical inpatients". J Am Geriatr Soc 51 (6): 754–60. PMID 12757560. [e]
- ↑ Inouye SK, van Dyck CH, Alessi CA, Balkin S, Siegal AP, Horwitz RI (December 1990). "Clarifying confusion: the confusion assessment method. A new method for detection of delirium". Ann. Intern. Med. 113 (12): 941–8. PMID 2240918. [e]
- ↑ Folstein MF, Folstein SE, McHugh PR (1975). ""Mini-mental state". A practical method for grading the cognitive state of patients for the clinician". Journal of psychiatric research 12 (3): 189-98. DOI:10.1016/0022-3956(75)90026-6. PMID 1202204. Research Blogging.
- ↑ Lonergan E, Britton AM, Luxenberg J, Wyller T (2007). "Antipsychotics for delirium". Cochrane Database Syst Rev (2): CD005594. DOI:10.1002/14651858.CD005594.pub2. PMID 17443602. Research Blogging.
- ↑ Breitbart W, Marotta R, Platt MM, et al (February 1996). "A double-blind trial of haloperidol, chlorpromazine, and lorazepam in the treatment of delirium in hospitalized AIDS patients". Am J Psychiatry 153 (2): 231–7. PMID 8561204. [e]
- ↑ Overshott R, Karim S, Burns A (2008). "Cholinesterase inhibitors for delirium". Cochrane Database Syst Rev (1): CD005317. DOI:10.1002/14651858.CD005317.pub2. PMID 18254077. Research Blogging.
- ↑ Dasgupta M, Dumbrell AC (October 2006). "Preoperative risk assessment for delirium after noncardiac surgery: a systematic review". J Am Geriatr Soc 54 (10): 1578–89. DOI:10.1111/j.1532-5415.2006.00893.x. PMID 17038078. Research Blogging.
- ↑ 10.0 10.1 Inouye SK, Viscoli CM, Horwitz RI, Hurst LD, Tinetti ME (September 1993). "A predictive model for delirium in hospitalized elderly medical patients based on admission characteristics". Ann. Intern. Med. 119 (6): 474–81. PMID 8357112. [e]
- ↑ Siddiqi N, Stockdale R, Britton AM, Holmes J (2007). "Interventions for preventing delirium in hospitalised patients". Cochrane Database Syst Rev (2): CD005563. DOI:10.1002/14651858.CD005563.pub2. PMID 17443600. Research Blogging.