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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.

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