Delirium
| Delirium | |
|---|---|
| Video explanation | |
| Classification and external resources | |
| Specialty | Psychiatry |
| ICD-10 | F05 |
| ICD-9-CM | 780.09 |
| DiseasesDB | 29284 |
| MedlinePlus | 000740 |
| eMedicine | med/3006 |
| Patient UK | Delirium |
| MeSH | D003693 |
Delirium, or acute confusional state, is an organically caused decline from a previously attained baseline level of cognitive function. It is typified by fluctuating course, attentional deficits and generalized severe disorganization of behavior. It typically involves other cognitive deficits, changes in arousal (hyperactive, hypoactive, or mixed), perceptual deficits, altered sleep-wake cycle, and psychotic features such as hallucinations and delusions.
Delirium itself is not a disease, but rather a clinical syndrome (a set of symptoms). It may result from an underlying disease, over-consumption of alcohol, from drugs administered during treatment of a disease, withdrawal from drugs or from any number of health factors. Delirium may be difficult to diagnose without the proper establishment of the baseline mental function of a patient.
Delirium may be caused by a disease process outside the brain that nonetheless affects the brain, such as infection (urinary tract infection, pneumonia) or drug effects, particularly anticholinergics or other CNS depressants (benzodiazepines and opioids). Although hallucinations and delusions are sometimes present in delirium, these are not required for the diagnosis, and the symptoms of delirium are clinically distinct from those induced by psychosis or hallucinogens (with the exception of deliriants.) Delirium must by definition be caused by an organic process, i.e., a physically identifiable structural, functional, or chemical problem in the brain (see organic brain syndrome), and thus, fluctuations of mentation due to changes in purely psychiatric processes or diseases, such as sudden psychosis from schizophrenia or bipolar disorder, are (by definition) not termed delirium. Like its components (inability to focus attention, mental confusion and various impairments in awareness and temporal and spatial orientation), delirium is the common manifestation of new organic brain dysfunction (for any reason). Delirium requires both a sudden change in mentation, and an organic cause for this. Thus, without careful assessment and history, delirium can easily be confused with a number of psychiatric disorders or long term organic brain syndromes, because many of the signs and symptoms of delirium are conditions also present in dementia, depression, and psychosis. Delirium may newly appear on a background of mental illness, baseline intellectual disability, or dementia, without being due to any of these problems.
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