Delirium overview

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Delirium Microchapters
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Patient Information
Overview
Historical Perspective
Classification
Pathophysiology
Causes
Differentiating Delirium from other Diseases
Epidemiology and Demographics
Risk Factors
Natural History, Complications and Prognosis
Diagnosis
Diagnostic Criteria
History and Symptoms
Physical Examination
Laboratory Findings
CT
MRI
Other Diagnostic Studies
Treatment
Medical Therapy
Primary Prevention
Secondary Prevention
Cost-Effectiveness of Therapy
Future or Investigational Therapies
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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 an acute and relatively sudden (developing over hours to days) decline in attention-focus, perception, and cognition. Delirium is commonly associated with a disturbance of consciousness or reduced clarity of awareness of the environment. The change in cognition including memory deficit, disorientation, language disturbance or the development of a perceptual disturbance may happen with rapid fluctuation course.The concept of delirium has been evolving over centuries. Delirium was first identified in the 16th century. In the second half of the 19th century, delirium was identified by French workers as chaotic thinking and cognitive failure, clouding of consciousness, temporospatial disorientation. The definition of confusion and delirium was established by Chaslin and Bonhoeffer as the stereotyped manifestations of acute brain failure.

Historical Perspective

The concept of delirium has been evolving over centuries. Delirium was first identified in the 16th century. In the second half of the 19th century, delirium was identified by French workers as chaotic thinking and cognitive failure, clouding of consciousness, temporospatial disorientation. The definition of confusion and delirium was established by Chaslin and Bonhoeffer as the stereotyped manifestations of acute brain failure.

Pathophysiology

Differentiating [disease name] from other Diseases

[Disease name] must be differentiated from other diseases that cause [clinical feature 1], [clinical feature 2], and [clinical feature 3], such as: [Differential dx1] [Differential dx2] [Differential dx3]

Epidemiology and Demographics

The prevalence of [disease name] is approximately [number or range] per 100,000 individuals worldwide. In [year], the incidence of [disease name] was estimated to be [number or range] cases per 100,000 individuals in [location]. Age Patients of all age groups may develop [disease name]. [Disease name] is more commonly observed among patients aged [age range] years old. [Disease name] is more commonly observed among [elderly patients/young patients/children]. Gender [Disease name] affects men and women equally. [Gender 1] are more commonly affected with [disease name] than [gender 2]. The [gender 1] to [Gender 2] ratio is approximately [number > 1] to 1. Race There is no racial predilection for [disease name]. [Disease name] usually affects individuals of the [race 1] race. [Race 2] individuals are less likely to develop [disease name].

Risk Factors

Common risk factors in the development of [disease name] are [risk factor 1], [risk factor 2], [risk factor 3], and [risk factor 4].

Natural History, Complications and Prognosis

The majority of patients with [disease name] remain asymptomatic for [duration/years]. Early clinical features include [manifestation 1], [manifestation 2], and [manifestation 3]. If left untreated, [#%] of patients with [disease name] may progress to develop [manifestation 1], [manifestation 2], and [manifestation 3]. Common complications of [disease name] include [complication 1], [complication 2], and [complication 3]. Prognosis is generally [excellent/good/poor], and the [1/5/10­year mortality/survival rate] of patients with [disease name] is approximately [#%].

Diagnosis

Diagnostic Criteria The diagnosis of [disease name] is made when at least [number] of the following [number] diagnostic criteria are met: [criterion 1] [criterion 2] [criterion 3] [criterion 4] History and Symptoms [Disease name] is usually asymptomatic. Symptoms of [disease name] may include the following: [symptom 1] [symptom 2] [symptom 3] [symptom 4] [symptom 5] [symptom 6]

Physical Examination

Patients with [disease name] usually appear [general appearance]. Physical examination may be remarkable for: [finding 1] [finding 2] [finding 3] [finding 4] [finding 5] [finding 6]

Laboratory Findings

There are no specific laboratory findings associated with [disease name]. A [positive/negative] [test name] is diagnostic of [disease name]. An [elevated/reduced] concentration of [serum/blood/urinary/CSF/other] [lab test] is diagnostic of [disease name]. Other laboratory findings consistent with the diagnosis of [disease name] include [abnormal test 1], [abnormal test 2], and [abnormal test 3].

Electrocardiogram

There are no ECG findings associated with [disease name].

OR

An ECG may be helpful in the diagnosis of [disease name]. Findings on an ECG suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].

X-ray There are no x-ray findings associated with [disease name].

OR

An x-ray may be helpful in the diagnosis of [disease name]. Findings on an x-ray suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].

OR

There are no x-ray findings associated with [disease name]. However, an x-ray may be helpful in the diagnosis of complications of [disease name], which include [complication 1], [complication 2], and [complication 3].

Echocardiography or Ultrasound There are no echocardiography/ultrasound findings associated with [disease name].

OR

Echocardiography/ultrasound may be helpful in the diagnosis of [disease name]. Findings on an echocardiography/ultrasound suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].

OR

There are no echocardiography/ultrasound findings associated with [disease name]. However, an echocardiography/ultrasound may be helpful in the diagnosis of complications of [disease name], which include [complication 1], [complication 2], and [complication 3].

CT scan

There are no CT scan findings associated with [disease name].

OR

[Location] CT scan may be helpful in the diagnosis of [disease name]. Findings on CT scan suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].

OR

There are no CT scan findings associated with [disease name]. However, a CT scan may be helpful in the diagnosis of complications of [disease name], which include [complication 1], [complication 2], and [complication 3].

MRI

There are no MRI findings associated with [disease name].

OR

[Location] MRI may be helpful in the diagnosis of [disease name]. Findings on MRI suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].

OR

There are no MRI findings associated with [disease name]. However, a MRI may be helpful in the diagnosis of complications of [disease name], which include [complication 1], [complication 2], and [complication 3].

Other Imaging Findings There are no other imaging findings associated with [disease name].

OR

[Imaging modality] may be helpful in the diagnosis of [disease name]. Findings on an [imaging modality] suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].

Other Diagnostic Studies There are no other diagnostic studies associated with [disease name].

OR

[Diagnostic study] may be helpful in the diagnosis of [disease name]. Findings suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].

OR

Other diagnostic studies for [disease name] include [diagnostic study 1], which demonstrates [finding 1], [finding 2], and [finding 3], and [diagnostic study 2], which demonstrates [finding 1], [finding 2], and [finding 3].

Treatment

Medical Therapy

There is no treatment for [disease name]; the mainstay of therapy is supportive care. The mainstay of therapy for [disease name] is [medical therapy 1] and [medical therapy 2]. [Medical therapy 1] acts by [mechanism of action 1]. Response to [medical therapy 1] can be monitored with [test/physical finding/imaging] every [frequency/duration]. Surgery Surgery is the mainstay of therapy for [disease name]. [Surgical procedure] in conjunction with [chemotherapy/radiation] is the most common approach to the treatment of [disease name]. [Surgical procedure] can only be performed for patients with [disease stage] [disease name].

Prevention

There are no primary preventive measures available for [disease name]. Effective measures for the primary prevention of [disease name] include [measure1], [measure2], and [measure3]. Once diagnosed and successfully treated, patients with [disease name] are followed-up every [duration]. Follow-up testing includes [test 1], [test 2], and [test 3].