Delirium overview: Difference between revisions
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==Overview== | ==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. [[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.The exact [[pathophysiology]] of [[delirium]] is still being investigated. The roles of [[neurotransmitters]] like [[acetylcholine]] and [[dopamine]] seem to be important. It involves disrupted connectivity between [[cortical]] and [[subcortical]] areas of the [[brain]], especially areas concerned with [[sleep]] and [[awakening]]. The role of increased inflammatory [[cytokines]] has been shown in [[delirious ]] [[patients]]. | [[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. [[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.The exact [[pathophysiology]] of [[delirium]] is still being investigated. The roles of [[neurotransmitters]] like [[acetylcholine]] and [[dopamine]] seem to be important. It involves disrupted connectivity between [[cortical]] and [[subcortical]] areas of the [[brain]], especially areas concerned with [[sleep]] and [[awakening]]. The role of increased inflammatory [[cytokines]] has been shown in [[delirious ]] [[patients]]. [[Delirium]] may be caused by severe physical or [[mental illness]], or any process which interferes with the normal metabolism or function of the brain such as [[fever]], [[pain]], [[poison]] ([[toxic]] [[approved drug|drug]] reactions), [[brain]] injury, [[surgery]], [[traumatic]] shock, severe lack of [[food]] or [[water]] or [[sleep]], and even withdrawal symptoms of certain [[drug]] and [[alcohol]] dependent states. In addition, there is an interaction between acute and chronic [[symptoms]] of [[brain]] dysfunction. [[Delirious]] states are more easily produced in people already suffering from underlying chronic [[brain]] dysfunction. A very common cause of [[delirium ]] in elderly people is a [[urinary tract infection]], which is easily treatable with [[antibiotics]]. | ||
[[Delirium]], like [[mental confusion]], is a very general and nonspecific symptom of [[organ]] dysfunction. In addition to many organic causes relating to a structural defect or a [[metabolic]] problem in the [[brain]], there are also some [[psychiatric]] causes, which may also include a component of [[mental]] or [[emotional]] stress, [[mental]] disease. | |||
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==Pathophysiology== | ==Pathophysiology== | ||
The exact [[pathophysiology]] of [[delirium]] is still being investigated. The roles of [[neurotransmitters]] like [[acetylcholine]] and [[dopamine]] seem to be important. It involves disrupted connectivity between [[cortical]] and [[subcortical]] areas of the [[brain]], especially areas concerned with [[sleep]] and [[awakening]]. The role of increased inflammatory [[cytokines]] has been shown in [[delirious ]] [[patients]]. | The exact [[pathophysiology]] of [[delirium]] is still being investigated. The roles of [[neurotransmitters]] like [[acetylcholine]] and [[dopamine]] seem to be important. It involves disrupted connectivity between [[cortical]] and [[subcortical]] areas of the [[brain]], especially areas concerned with [[sleep]] and [[awakening]]. The role of increased inflammatory [[cytokines]] has been shown in [[delirious ]] [[patients]]. | ||
==Causes== | |||
[[Delirium]] may be caused by severe physical or [[mental illness]], or any process which interferes with the normal metabolism or function of the brain such as [[fever]], [[pain]], [[poison]] ([[toxic]] [[approved drug|drug]] reactions), [[brain]] injury, [[surgery]], [[traumatic]] shock, severe lack of [[food]] or [[water]] or [[sleep]], and even withdrawal symptoms of certain [[drug]] and [[alcohol]] dependent states. In addition, there is an interaction between acute and chronic [[symptoms]] of [[brain]] dysfunction. [[Delirious]] states are more easily produced in people already suffering from underlying chronic [[brain]] dysfunction. A very common cause of [[delirium ]] in elderly people is a [[urinary tract infection]], which is easily treatable with [[antibiotics]]. | |||
[[Delirium]], like [[mental confusion]], is a very general and nonspecific symptom of [[organ]] dysfunction. In addition to many organic causes relating to a structural defect or a [[metabolic]] problem in the [[brain]], there are also some [[psychiatric]] causes, which may also include a component of [[mental]] or [[emotional]] stress, [[mental]] disease. | |||
==Differentiating [disease name] from other Diseases== | ==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: | [Disease name] must be differentiated from other diseases that cause [clinical feature 1], [clinical feature 2], and [clinical feature 3], such as: | ||
Revision as of 11:32, 22 April 2021
| https://https://www.youtube.com/watch?v=qmMYsVaZ0zo%7C350}} |
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Delirium Microchapters |
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Diagnosis |
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Treatment |
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Delirium On the Web |
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American Roentgen Ray Society Images of Delirium |
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. 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.The exact pathophysiology of delirium is still being investigated. The roles of neurotransmitters like acetylcholine and dopamine seem to be important. It involves disrupted connectivity between cortical and subcortical areas of the brain, especially areas concerned with sleep and awakening. The role of increased inflammatory cytokines has been shown in delirious patients. Delirium may be caused by severe physical or mental illness, or any process which interferes with the normal metabolism or function of the brain such as fever, pain, poison (toxic drug reactions), brain injury, surgery, traumatic shock, severe lack of food or water or sleep, and even withdrawal symptoms of certain drug and alcohol dependent states. In addition, there is an interaction between acute and chronic symptoms of brain dysfunction. Delirious states are more easily produced in people already suffering from underlying chronic brain dysfunction. A very common cause of delirium in elderly people is a urinary tract infection, which is easily treatable with antibiotics. Delirium, like mental confusion, is a very general and nonspecific symptom of organ dysfunction. In addition to many organic causes relating to a structural defect or a metabolic problem in the brain, there are also some psychiatric causes, which may also include a component of mental or emotional stress, mental disease.
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
The exact pathophysiology of delirium is still being investigated. The roles of neurotransmitters like acetylcholine and dopamine seem to be important. It involves disrupted connectivity between cortical and subcortical areas of the brain, especially areas concerned with sleep and awakening. The role of increased inflammatory cytokines has been shown in delirious patients.
Causes
Delirium may be caused by severe physical or mental illness, or any process which interferes with the normal metabolism or function of the brain such as fever, pain, poison (toxic drug reactions), brain injury, surgery, traumatic shock, severe lack of food or water or sleep, and even withdrawal symptoms of certain drug and alcohol dependent states. In addition, there is an interaction between acute and chronic symptoms of brain dysfunction. Delirious states are more easily produced in people already suffering from underlying chronic brain dysfunction. A very common cause of delirium in elderly people is a urinary tract infection, which is easily treatable with antibiotics. Delirium, like mental confusion, is a very general and nonspecific symptom of organ dysfunction. In addition to many organic causes relating to a structural defect or a metabolic problem in the brain, there are also some psychiatric causes, which may also include a component of mental or emotional stress, mental disease.
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].