Delirium is
a rapidly developing disorder of disturbed attention that fluctuates
with time. Although
the clinical presentation of delirium differs considerably from
patient to patient, there are several characteristic features
that help make the diagnosis.
Delirium
Due to a General Medical Condition
The patient has a reduced level of consciousness and difficulty
focusing, shifting or sustaining attention.
There has been a cognitive change (deficit of language, memory,
orientation, perception) that a dementia cannot better explain.
These symptoms develop rapidly (hours to days) and tend to vary
during the day.
History, physical examination or laboratory data suggest that
a general medical condition has directly caused the condition.
Criteria
for Substance Intoxication Delirium
The patient has a reduced level of consciousness and difficulty
focusing, shifting or sustaining attention.
There has been a cognitive change (deficit of language, memory,
orientation, perception) that a dementia cannot better explain.
These symptoms develop rapidly (hours to days) and tend to fluctuate
during the day.
History, physical examination or laboratory data suggest that
either:
The symptoms
developed during Substance Intoxication or
They are caused by the use of a medication
Criteria
for Substance Withdrawal Delirium
The patient has a reduced level of consciousness and difficulty
focusing, shifting or sustaining attention.
There has been a cognitive change (deficit of language, memory,
orientation, perception) that a dementia cannot better explain.
These symptoms develop rapidly (hours to days) and tend to fluctuate
during the day.
History, physical examination or laboratory data suggest that
the symptoms developed during or shortly after Substance Withdrawal.
Criteria
for Delirium Due to Multiple Etiologies
The patient has a reduced level of consciousness and difficulty
focusing, shifting or sustaining attention.
There has been a cognitive change (deficit of language, memory,
orientation, perception) that a dementia cannot better explain.
These symptoms develop rapidly (hours to days) and tend to fluctuate
during the day.
These symptoms have more than one cause, as judged by history,
physical examination or laboratory data.
Associated
Features:
Learning
Problem
Dysarthria or Involuntary Movement
Hypoactivity
Psychosis
Euphoric
Mood
Depressed
Mood
Somatic
or Sexual Dysfunction
Hyperactivity
Addiction
Sexually
Deviant Behavior
Differential
Diagnosis:
Some disorders have similar or even overlapping symptoms. The
clinician, therefore, in his diagnostic attempt, has to differentiate
against the following disorders which need to be ruled out to
establish a precise diagnosis. The
major problem in differential diagnosis is in distinguishing a
delirium from an acute functional psychosis. The
delirious patient is usually more acute and confused, and the
hallucinations are usually more disorganized and are more likely
to be visual. Patients
with functional psychoses usually don’t have confusion, disorientation,
and illusions, and they are more likely to have a formal thought
disorder. It is wise
to also check a patients personal and family history for serious
psychiatric illness.
Schizophrenia.
Schizophreniform Disorder
and other psychotic disorders.
Dementia.
Factitious Disorder with Psychological
Symptoms.
Cause:
This
common condition may be caused by physical illness, several causes
simultaneously, or by unknown organic conditions.
Treatment:
Most causes
produce diffuse cerebral impairment and lie outside the Central
Nervous System and is usually due to some form of deranged metabolism
(infection, fever, hypoxia, hypoglycemia, medication side effects,
drug withdrawal states, hepatic encephalopathy, postoperative
changes), but also include Central Nervous System trauma.
The
objective of treatment is to control and/or reverse symptoms.
Treatment varies with the specific condition causing delirium.
Medications
that may be considered for use include:
Thiamine.
Anti-psychotics.
Beta-blockers if dementia is related to central nervous system
lesions.
Serotonin-affecting drugs (lithium, trazodone, buspirone, clonazepam).
Dopamine blockers (such as haloperidol).
Fluoxetine, imipramine may be used to stabilize mood.
Stimulant drugs, may improve mood.
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