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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[2]

[3]

@@ Line 1: / Line 1: @@
 __NOTOC__
 {{Delirium}}
-{{CMG}}; {{AE}} [[User:Vishal Khurana|Vishal Khurana]], M.B.B.S., M.D. [mailto:vishdoc24@gmail.com] ; {{PB}}
+{{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. 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==
-DSM V specifies delirium by various virtues,
+[[Delirium]] may be classified into the following:
-: '''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
-Also,
-: '''Acute''': Duration is restricted to a few hours to says
-: '''Persistent''': when delirium lasts for weeks or months.
-And,
-: '''Hyperactive''': An increased psychomotor activity which may cooccue with incresed 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 stupour.
+{| 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}}
-: '''Mixed level of activity''': A normal level of psychomotor activity, individuals with rapidly fluctuating activity are also included in this category.<refname="www.dsm5.org">{{Cite web  | last =  | first =  | title = http://www.dsm5.org/Pages/Default.aspx | url = http://www.dsm5.org/Pages/Default.aspx |publisher =  | date =  | accessdate = }}</ref> <ref name="www.ncbi.nlm.nih.gov">{{Cite web  | last =  | first =  | title = Delirium in elderly people. [Lancet. 2013] - PubMed - NCBI | url = http://www.ncbi.nlm.nih.gov/pubmed/23992774 | publisher =  | date =  | accessdate =}}</ref>
-: <font color="#777777"></font>
-Some authours have described fourth type of delirium, called as '''Subsyndromal delirium''' (an incomplete form of delirium)<ref name="www.bmj.com">{{Cite web  | last =  | first =  | title = Delirium in older people | BMJ | url =http://www.bmj.com/content/334/7598/842 | publisher =  | date =  | accessdate =}}</ref>
+{| border="1" cellpadding="5" cellspacing="0"
+|-
+!Classification based on || Types
+|-
+| rowspan="4"| Etiology
+| colspan="2" align="Left"| [[Substance]] [[intoxication]] [[delirium]]
+|-
+| colspan="2" align="Left"| [[Substance]] [[withdrawal]] [[delirium]]
+|-
+| colspan="2" align="Left"| [[Delirium]] caused by another [[medical]] [[condition]]
+|-
+| colspan="2" align="Left"| [[Delirium]] caused by multiple [[etiologies]]
+|-
+| rowspan="2"| Duration
+| colspan="2" align="Left"| [[Acute]]
+|-
+| colspan="2" align="Left"| [[Persistent]]
+|-
+| rowspan="3"| Severity
+| colspan="2" align="Left"| [[Hyperactive]]
+|-
+| colspan="2" align="Left"| [[Hypoactive]]
+|-
+| colspan="2" align="Left"| Mixed level of activity
+|}
-Phenomenological findings of different motoric subtypes of delirium reveal that purely hypoactive (somnolent) or hyperactive (agitated) patients appear to bemonority of cases, with more than 50% of patients experiencing a mixed profile during the course of their illness.<ref>Koponen et al 1989</ref><ref>Liptzin and Levkoff 1992</ref><ref>Maegher et al 1996</ref>
+===Based on Duration===
-<br>
+* '''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]].<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>
+Some authors have described a fourth type of delirium called as subsyndromal [[delirium]], which is an incomplete form of [[delirium]].<ref name="Young-2007">{{Cite journal  | last1 = Young | first1 = J. | last2 = Inouye | first2 = SK. | title = Delirium in older people. | journal = BMJ | volume = 334 | issue = 7598 | pages = 842-6 | month = Apr | year = 2007 | doi = 10.1136/bmj.39169.706574.AD | PMID = 17446616 }}</ref>
 ==References==