Deliriumby:

Adilia Adris

Definition An acute organic reaction (mental state) with the major disturbance, clouding of consciousness, concurrence with disturbances of attention, orientation, memory, perception, delusion, restlessness and agitation.

Short term confusion ( acute confusional state) and changes in levels of consciousness

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Epidemiologyaffects 15 to 50% of hospitalized people aged 70 or older.may occur at any age but is more common among older people. When delirium occurs in younger people, it is usually due to drug use or a life-threatening disorder.

Etiology Systemic infectionEg: any infection esp with high fever like

malaria

Metabolic disturbanceseg: hepatic failure, renal failure, dehydration, hypoxia, electrolyte imbalance

Vitamin deficiencyEg: B1, B12

Endocrine diseaseHypothyroidismCushing’s syndrome

Intracranial causesTraumaTumorAbcessEpilepsySubarachnoid haemorrhage

Drug intoxicationAnticonvulsantsAntimuscarinicsAnxiolyticsTricyclic antidepressant

Drug/ alcohol withdrawalPostoperative statesTerminal illness

Subcategories ( DSM-IV)Delirium

Substance induced

Substance withdrawal

Substance Intoxication

General Medical Condition

Multiple Etiologies

Delirium Not Otherwise Specified

Symptoms (Key Features) Altered consciousness with hyperarousal OR hypoarousal with agitation or apathyMemory impairmentDisorientationIllogical speechSevere emotional lability perceptual disturbances -Hallucinations (auditory/visual/ Tactile)Fragmented sleep (sleep-wake cycle disturbance)Fluctuating levels of consciousness

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Neurological symptoms

IncoordinationDysphasiaTremorAsterixisAtaxiaApraxia

Diagnostic Criteria for Delirium

Delirium due to a General Medical Condition1. Disturbances of consciousness2. A change in cognition or the development of

a perceptual disturbance that is not better accouted for by preexisting, established, or evolving dementia.

3. The disturbance develops over a short period of time and tends to fluctuate during the course of the day

4. There is evidance from the history , physical examination , or laboratory findings that the disturbance is caused by the direct physiological consequences of a general medical condition.

Substance intoxication delirium

1. Disturbance of consciousness with reduced ability to focus, sustain, or shift attention.

2. A change in cognition or the development of a perceptual disturbance that is not better accounted for by preexisting, established, or evolving dementia.

3. The disturbance develops over a short period of time and tends to fluctuate during the course of the day

4. There is evidence from the history , physical examination , or laboratory findings of either (1) or (2)

The symptoms in criteria A and B developed during substance intoxication

Medication used is etiologically related to the disturbance

Substance withdrawal delirium1. Disturbance of consciousness with reduced ability

to focus, sustain, or shift attention.2. A change in cognition or the development of a

perceptual disturbance that is not better accounted for by preexisting, established, or evolving dementia.

3. The disturbance develops over a short period of time and tends to fluctuate during the course of the day

4. There is evidence from the history , physical examination , or laboratory findings that the symptoms in criteria A and B developed during , or shortly after , a withdrawal syndrome

Delirium due to multiple etologies1. Disturbance of consciousness with reduced

ability to focus, sustain, or shift attention.2. A change in cognition or the development of

a perceptual disturbance that is not better accounted for by preexisting, established, or evolving dementia.

3. The disturbance develops over a short period of time and tends to fluctuate during the course of the day

4. There is evidence from the history , physical examination , or laboratory findings that the delirium has ore than one etiology

Delirium Not Otherwise Specified

This category should be used to diagnose a delirium that does not Meet the criteria for any of the specific types of delirium described in this section.

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PatophysiologyDelirium is a result of the diffuse damage

from the nerve tissue metabolismThis can be seen from :

EEG studygeneralized slowing activity of EEGslowing of the low amplitudo

Blood flow in the brain reduce usage of O2

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Differential DiagnosisDementia SchizophreniaPsychosisDepression

DELIRIUM vs DEMENTIA?Features  Delirium  Dementia 

Onset Acute Insidious

Course Fluctuating Progressive

Duration Days to weeks Months to years

Consciousness

Altered Clear

Attention Impaired Normal, except in severe dementia

Psychomotor changes

Increased or decreased

Often normal

Reversibility Usually Rarely

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Therapy Treatment of underlying cause Medical care Drugs to control agitated and agressive

behaviourAntidepresssants (fluoxetine, citalopram)Dopamine blockers (haloperidol 5-10 mg/IM)Sedatives (clonazepam or diazepam)Thiamine

Symptomatic therapy1. Antipsychotic :2. Benzodiazepine : diazepam 10 mg/IM

ComplicationsLoss of ability to function or care for selfLoss of ability to interactProgression to stupor or comaSide effects of medications used to treat the

disorder

Prognosisoften lasts only about 1 week, although it

may take several weeks for mental function to return to normal

Full recovery is common.