Delirium

Definition:

• Delirium is an acute neuropsychiatric syndrome characterized by a disturbance in attention, awareness, and cognition that develops over a short period of time and tends to fluctuate during the course of the day.

Epidemiology:

• Common in hospitalized patients, especially older adults, postoperative patients, and those in intensive care units.
• Often underdiagnosed.

Etiology:

• Multifactorial: Infections, metabolic imbalances, medication side effects, withdrawal from substances (alcohol, benzodiazepines), acute stress, trauma, and pre-existing cognitive impairment.
• Precipitated by multiple triggers, especially in vulnerable individuals.

Types:

1. Hyperactive Delirium: Characterized by restlessness, agitation, and hyper-vigilance.
2. Hypoactive Delirium: Presents with lethargy, reduced motor activity, and decreased responsiveness.
3. Mixed Delirium: Features of both hyperactive and hypoactive types.

Clinical Features:

• Fluctuating levels of consciousness.
• Impaired attention and disorganized thinking.
• Disorientation, memory impairment, perceptual disturbances.
• Altered sleep-wake cycle.
• Emotional disturbances such as anxiety, fear, or irritability.

Diagnosis:

• Clinical diagnosis based on history, physical examination, and mental status examination.
• Tools like the Confusion Assessment Method (CAM) can aid in diagnosis.
• Investigations to identify underlying causes: Blood tests, urinalysis, chest X-ray, CT/MRI of the brain, ECG.

Management:

• Treat the underlying cause.
• Non-pharmacological interventions are first-line: Reorientation, ensuring adequate hydration and nutrition, sleep hygiene, minimizing sensory impairments.
• Pharmacological treatment (e.g., antipsychotics) may be needed for severe agitation or risk of harm.
• Prevention strategies in at-risk populations.

Prognosis:

• Varies based on the underlying cause and promptness of treatment.
• Can lead to increased mortality, prolonged hospital stay, and a higher chance of admission to long-term care facilities.