Delirium classification: Difference between revisions

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Latest revision as of 08:23, 22 April 2021

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Sara Zand, M.D.[2] Pratik Bahekar, MBBS [3]; Vishal Khurana, M.B.B.S., M.D. [4]

Overview

Delirium is classified on the basis of etiology, duration, and severity. Hyperactive delirium is defined as increased psychomotor activity, which may occur with increased mood lability, agitation, non cooperative attitude towards medical treatment. Hypoactive delirium is explained by a hypoactive level of psychomotor activity, which may exist along with increased lethargy or stupor, inattentiveness and motor slowness and is much more common among ICU admitted patients with severe disease.

Types of Delirium

Delirium may be classified into the following:

Diagnostic and Statistical Manual (DSM)-5	World Health Organization's International Classification of Diseases (10th revision)	ICD-10
Disturbance in attention and awareness (reduced ability to direct, focus, shift attention and reduced orientation to envinment) Initiation of disturbance over a short period of time during several hours or days with fluctuation in severity over a day Disturbance in cognition (memory deficit, disorientation, language, visuospatial ability, perception Disturbance other than evolving neurocognitive disorder Disturbance due to medical condition, substance intoxication, or withdrawal, toxin exposure	Disturbance in cognition Impairment of immediate recall and recent memory Disorientation to time, place, person	Disturbance in sleep wake cycle Psychomotor disturbances Emotional disturbances Upper limit time: 6 months

Classification based on	Types
Etiology	Substance intoxication delirium
	Substance withdrawal delirium
	Delirium caused by another medical condition
	Delirium caused by multiple etiologies
Duration	Acute
Duration	Persistent
Severity	Hyperactive
	Hypoactive
	Mixed level of activity

Based on Duration

Acute: When delirium lasts for a few hours to days.
Persistent: When delirium lasts for weeks or months.

Based on Severity

Hyperactive: An increased psychomotor activity, which may co-occur with, increased mood lability, agitation, and/or non cooperative attitude towards medical treatment.
Hypoactive: A hypoactive level of psychomotor activity, which may exist along with increased sluggishness, lethargy or stupor, inattentiveness and motor slowness and is much more common among ICU admitted patients with severe disease.^[1]
Mixed level of activity: A normal level of psychomotor activity, individuals with rapidly fluctuating activity are also included in this category.^[2]

Some authors have described a fourth type of delirium called as subsyndromal delirium, which is an incomplete form of delirium.^[3]

References

↑ Krewulak, Karla D.; Stelfox, Henry T.; Leigh, Jeanna Parsons; Ely, E. Wesley; Fiest, Kirsten M. (2018). "Incidence and Prevalence of Delirium Subtypes in an Adult ICU". Critical Care Medicine. 46 (12): 2029–2035. doi:10.1097/CCM.0000000000003402. ISSN 0090-3493.
↑ Inouye, SK.; Westendorp, RG.; Saczynski, JS. (2013). "Delirium in elderly people". Lancet. doi:10.1016/S0140-6736(13)60688-1. PMID 23992774. Unknown parameter |month= ignored (help)
↑ Young, J.; Inouye, SK. (2007). "Delirium in older people". BMJ. 334 (7598): 842–6. doi:10.1136/bmj.39169.706574.AD. PMID 17446616. Unknown parameter |month= ignored (help)

Template:WH Template:WS

[KrewulakStelfox2018-1] Krewulak, Karla D.; Stelfox, Henry T.; Leigh, Jeanna Parsons; Ely, E. Wesley; Fiest, Kirsten M. (2018). "Incidence and Prevalence of Delirium Subtypes in an Adult ICU". Critical Care Medicine. 46 (12): 2029–2035. doi:10.1097/CCM.0000000000003402. ISSN 0090-3493.

[Inouye-2013-2] Inouye, SK.; Westendorp, RG.; Saczynski, JS. (2013). "Delirium in elderly people". Lancet. doi:10.1016/S0140-6736(13)60688-1. PMID 23992774. Unknown parameter |month= ignored (help)

[Young-2007-3] Young, J.; Inouye, SK. (2007). "Delirium in older people". BMJ. 334 (7598): 842–6. doi:10.1136/bmj.39169.706574.AD. PMID 17446616. Unknown parameter |month= ignored (help)

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@@ Line 1: / Line 1: @@
 __NOTOC__
 {{Delirium}}
-{{CMG}}; {{AE}} {{PB}}; [[User:Vishal Khurana|Vishal Khurana]], M.B.B.S., M.D. [mailto:vishdoc24@gmail.com]
+{{CMG}}; {{AE}} {{Sara.Zand}} {{PB}}; [[User:Vishal Khurana|Vishal Khurana]], M.B.B.S., M.D. [mailto:vishdoc24@gmail.com]
 ==Overview==
-Delirium is classified on the basis of etiology, duration and severity.
+[[Delirium]] is classified on the basis of etiology, duration, and severity. Hyperactive [[delirium]] is defined as increased [[psychomotor]] activity, which may occur with increased [[mood]] [[lability]], [[agitation]], non cooperative [[attitude]] towards [[medical]] treatment. Hypoactive [[delirium]] is explained by a hypoactive level of [[psychomotor]] activity, which may exist along with increased [[lethargy]] or [[stupor]], [[inattentiveness]] and [[motor]] slowness and is much more common among [[ICU]] admitted [[patients]] with severe disease.
 ==Types of Delirium==
-The classification and definitions of different types of delirium as per the Diagnostic and Statistical Manual of Mental Disorders V (DSM V) is as follows.
+[[Delirium]] may be classified into the following:
+{| style="border: 2px solid #4479BA; align="left"
+! style="width: 200px; background: #4479BA;" | {{fontcolor|#FFF|Diagnostic and Statistical Manual (DSM)-5}}
+! style="width: 300px; background: #4479BA;" | {{fontcolor|#FFF|World Health Organization's International Classification of Diseases (10th revision)}}
+! style="width: 400px; background: #4479BA;" | {{fontcolor|#FFF|ICD-10}}
+|-
+| style="padding: 0 5px; background: #F5F5F5; text-align: left;" |
+* Disturbance in [[attention]] and [[awareness]] (reduced ability to direct, focus, shift [[attention]] and reduced [[orientation]] to [[envinment]])
+*Initiation of disturbance over a short period of time during several hours or days  with fluctuation  in severity over a day
+*Disturbance in [[cognition]] ([[memory deficit]], [[disorientation]], [[language]], [[visuospatial]] ability, [[perception]]
+* Disturbance other than evolving [[neurocognitive]] disorder
+* Disturbance due to medical [[condition]], [[substance intoxication]], or withdrawal, [[toxin]] [[exposure]]
+| style="padding: 0 5px; background: #F5F5F5; text-align: left;" |
+*Disturbance in [[cognition]]
+*Impairment of [[immediate recall]] and [[recent memory]]
+*[[Disorientation]] to [[time]], [[place]], [[person]]
+| style="padding: 0 5px; background: #F5F5F5; text-align: left;" |
+*Disturbance in [[sleep wake]] cycle
+* [[Psychomotor disturbances]]
+* [[Emotional disturbances]]
+* Upper limit [[time]]: 6 months
+|-
+|}
+{{clear}}
 {| border="1" cellpadding="5" cellspacing="0"
@@ Line 34: / Line 59: @@
 | colspan="2" align="Left"| Mixed level of activity
 |}
-===Based on Etiology===
-* '''Substance intoxication delirium''': Diagnosis of [[substance intoxication]] [[delirium]] is made rather than substance [[intoxication]], when the symptoms in Criteria A and C predominate and are severe enough to require clinical attention.
-* '''Substance withdrawal delirium''': Diagnosis of [[substance withdrawal]] [[delirium]] is made rather than substance withdrawal, when the [[symptoms]] in Criteria A and C predominate and are severe enough to require clinical attention.
-* '''Delirium caused by another medical condition''': When delirium is caused by another medical condition.
-* '''Delirium caused by multiple etiologies''': [[Delirium]] is a consequence of multiple causes e.g. [[medical]] [[condition]] plus [[substance intoxication]] or side effect of [[medications]].
 ===Based on Duration===
@@ Line 47: / Line 66: @@
 ===Based on Severity===
 * '''Hyperactive''': An increased [[psychomotor]] activity, which may co-occur with, increased [[mood]] [[lability]], [[agitation]], and/or non cooperative [[attitude]] towards medical treatment.
-* '''Hypoactive''': A hypoactive level of psychomotor activity, which may exist along with increased [[sluggishness]], [[lethargy]] or [[stupor]] and is much more common among [[ICU]] admitted [[patients]] with severe [[disease]].<ref name="KrewulakStelfox2018">{{cite journal|last1=Krewulak|first1=Karla D.|last2=Stelfox|first2=Henry T.|last3=Leigh|first3=Jeanna Parsons|last4=Ely|first4=E. Wesley|last5=Fiest|first5=Kirsten M.|title=Incidence and Prevalence of Delirium Subtypes in an Adult ICU|journal=Critical Care Medicine|volume=46|issue=12|year=2018|pages=2029–2035|issn=0090-3493|doi=10.1097/CCM.0000000000003402}}</ref>
+* '''Hypoactive''': A hypoactive level of psychomotor activity, which may exist along with increased [[sluggishness]], [[lethargy]] or [[stupor]], [[inattentiveness]] and [[motor]] slowness and is much more common among [[ICU]] admitted [[patients]] with severe [[disease]].<ref name="KrewulakStelfox2018">{{cite journal|last1=Krewulak|first1=Karla D.|last2=Stelfox|first2=Henry T.|last3=Leigh|first3=Jeanna Parsons|last4=Ely|first4=E. Wesley|last5=Fiest|first5=Kirsten M.|title=Incidence and Prevalence of Delirium Subtypes in an Adult ICU|journal=Critical Care Medicine|volume=46|issue=12|year=2018|pages=2029–2035|issn=0090-3493|doi=10.1097/CCM.0000000000003402}}</ref>
 * '''Mixed level of activity''': A normal level of [[psychomotor]] activity, individuals with rapidly fluctuating activity are also included in this category.<ref name="Inouye-2013">{{Cite journal  | last1 = Inouye | first1 = SK. | last2 = Westendorp | first2 = RG. | last3 = Saczynski | first3 = JS. | title = Delirium in elderly people. | journal = Lancet | volume =  | issue =  | pages =  | month = Aug | year = 2013 | doi = 10.1016/S0140-6736(13)60688-1 | PMID = 23992774 }}</ref>