Delirium - Revision history

Danbot: Strip excess bold

2026-03-22T09:26:09Z

Strip excess bold

Danbot: Expand with concise EM-focused content: DELIRIUM mnemonic, subtypes, CAM criteria, non-pharm management

2026-03-21T01:28:21Z

Expand with concise EM-focused content: DELIRIUM mnemonic, subtypes, CAM criteria, non-pharm management

← Older revision		Revision as of 01:28, 21 March 2026
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	==Background==		==Background==
	*~~Also known as "acute toxic~~-~~metabolic encephalopathy"~~		*Acute disturbance of consciousness with fluctuating inattention and cognitive dysfunction
	*~~Delirium vs.~~ [[dementia]] ~~vs. psych~~		*Caused by an underlying medical condition — NOT a primary psychiatric disorder
			*Extremely common: affects 10-30% of hospitalized elderly patients
			*Associated with increased mortality, prolonged hospitalization, and long-term cognitive decline
			*'''Key distinction from [[dementia]]:''' Delirium is acute (hours-days), fluctuating, with inattention as primary deficit; dementia is chronic (months-years) with memory as primary deficit

	==Clinical Features==		==Clinical Features==
	*~~Main cognitive impairment is that of inattention~~ (~~vs memory in dementia~~)		*'''Inattention''' — hallmark feature (cannot maintain or shift attention appropriately)
	*~~Generally develops~~ over hours to days		*Fluctuating course throughout the day
	*~~Symptoms are classically described as fluctuating throughout the day~~ (~~ie may appear normal in~~ between ~~episodes)~~		*Develops over hours to days (acute onset)
			*'''Subtypes:'''
			**'''Hyperactive:''' agitation, restlessness, hallucinations, combativeness (easier to diagnose)
			**'''Hypoactive:''' lethargy, decreased responsiveness, withdrawn (frequently missed — more common and more dangerous)
			**'''Mixed:''' alternating between hyperactive and hypoactive states

	===~~ED Confusion Assessment Method<ref>Inouye SK, van Dyck CH, Alessi CA, et al. Clarifying confusion~~: ~~the confusion assessment method. A new method for detection of delirium. Ann Intern Med 1990; 113:941.</ref>~~===		===Common Causes (mnemonic: DELIRIUM)===
	*~~Acute onset~~ of ~~[[mental status changes]] and~~/~~or fluctuating course~~		*'''D'''rugs (anticholinergics, opioids, benzodiazepines, steroids, polypharmacy)
	*~~Inattention~~		*'''E'''lectrolyte abnormalities, '''E'''ndocrine (thyroid, adrenal, glucose)
	*~~Disorganized thinking~~		*'''L'''ack of drugs (withdrawal from alcohol, benzodiazepines, opioids)
	*~~[[Altered level of consciousness]]~~		*'''I'''nfection (UTI, pneumonia, meningitis, sepsis)
			*'''R'''educed sensory input (vision/hearing impairment, ICU environment)
			*'''I'''ntracranial pathology (stroke, hemorrhage, mass, seizure)
			*'''U'''rinary retention, constipation (especially in elderly)
			*'''M'''yocardial/pulmonary (MI, PE, hypoxia, CHF)

	~~A patient must possess~~ both features 1 ~~and~~ 2 ~~AND~~ either 3 or ~~4 to meet delirium criteria~~		===Confusion Assessment Method (CAM)===
			*Must have '''both''' features 1 AND 2 '''plus''' either 3 OR 4:
			*#Acute onset and/or fluctuating course
			*#Inattention
			*#Disorganized thinking
			*#Altered level of consciousness

	==Differential Diagnosis==		==Differential Diagnosis==
	{{AMS DDX}}		{{AMS DDX}}

	{{Psych DDX}}		{{Psych DDX}}

	==Evaluation==		==Evaluation==
	''~~Main goal is to find~~ the underlying cause''		*'''Goal: identify and treat the underlying cause'''
	{{AMS workup}}		{{AMS workup}}
			*Minimum: glucose, BMP, CBC, urinalysis, [[ECG]], [[CXR]]
			*Consider: LFTs, ammonia, TSH, blood cultures, lactate, [[urine toxicology screen]]
			*CT head if: focal neuro findings, fall/head trauma, anticoagulation, no clear cause identified
			*LP if meningitis/encephalitis suspected

	==Management==		==Management==
	*Treat underlying cause		*'''Treat the underlying cause''' — this is the definitive management
	*~~Antipsychotics~~ (eg [[~~haloperidol~~]], [[~~risperidone~~]]) ~~may be useful for hyperactive delirium with psychotic features~~		*Non-pharmacologic measures first: reorientation, quiet environment, sleep-wake cycle preservation, mobilization, adequate hydration/nutrition, correct sensory deficits (glasses, hearing aids)
			*'''Pharmacologic (for severe hyperactive delirium with safety concerns):'''
			**[[Haloperidol]] 0.5-2 mg IV/IM (start low in elderly)
			**[[Olanzapine]] 2.5-5 mg IM
			**Avoid benzodiazepines (worsen delirium — exception: alcohol/benzo withdrawal)
			*Review and discontinue deliriogenic medications when possible

	==Disposition==		==Disposition==
	*~~Admission~~		*Admit for workup and treatment of underlying cause
			*ICU if hemodynamically unstable, severe agitation, or respiratory compromise

	==See Also==		==See Also==
	*[[Altered ~~Mental Status~~]]		*[[Altered mental status]]
			*[[Agitated delirium]]
			*[[Dementia]]
			*[[Acute psychosis]]
			*[[Sundowning]]

	==References==		==References==

ClaireLewis at 15:17, 27 September 2019

2019-09-27T15:17:49Z

← Older revision		Revision as of 15:17, 27 September 2019
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	===ED Confusion Assessment Method<ref>Inouye SK, van Dyck CH, Alessi CA, et al. Clarifying confusion: the confusion assessment method. A new method for detection of delirium. Ann Intern Med 1990; 113:941.</ref>===		===ED Confusion Assessment Method<ref>Inouye SK, van Dyck CH, Alessi CA, et al. Clarifying confusion: the confusion assessment method. A new method for detection of delirium. Ann Intern Med 1990; 113:941.</ref>===
	*Acute onset of mental status changes and/or fluctuating course		*Acute onset of [[mental status changes]] and/or fluctuating course
	*~~Anattention~~		*Inattention
	*Disorganized thinking		*Disorganized thinking
	*Altered level of consciousness		*[[Altered level of consciousness]]

	A patient must possess both features 1 and 2 AND either 3 or 4 to meet delirium criteria		A patient must possess both features 1 and 2 AND either 3 or 4 to meet delirium criteria
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	==Management==		==Management==
	*Treat underlying cause		*Treat underlying cause
	*Antipsychotics (eg [[haloperidol]], risperidone) may be useful for hyperactive delirium with psychotic features		*Antipsychotics (eg [[haloperidol]], [[risperidone]]) may be useful for hyperactive delirium with psychotic features

	==Disposition==		==Disposition==

Rossdonaldson1: Text replacement - " haloperidol" to " haloperidol"

2016-08-03T06:19:58Z

Text replacement - " haloperidol" to " haloperidol"

← Older revision		Revision as of 06:19, 3 August 2016
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	==Management==		==Management==
	*Treat underlying cause		*Treat underlying cause
	*Antipsychotics (eg haloperidol, risperidone) may be useful for hyperactive delirium with psychotic features		*Antipsychotics (eg [[haloperidol]], risperidone) may be useful for hyperactive delirium with psychotic features

	==Disposition==		==Disposition==

Neil.m.young: Text replacement - "==Diagnosis==" to "==Evaluation=="

2016-07-24T01:45:27Z

Text replacement - "==Diagnosis==" to "==Evaluation=="

← Older revision		Revision as of 01:45, 24 July 2016
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	{{Psych DDX}}		{{Psych DDX}}

	==~~Diagnosis~~==		==Evaluation==
	''Main goal is to find the underlying cause''		''Main goal is to find the underlying cause''
	{{AMS workup}}		{{AMS workup}}

Neil.m.young: Text replacement - "==Treatment==" to "==Management=="

2016-07-07T07:00:28Z

Text replacement - "==Treatment==" to "==Management=="

← Older revision		Revision as of 07:00, 7 July 2016
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	{{AMS workup}}		{{AMS workup}}

	==~~Treatment~~==		==Management==
	*Treat underlying cause		*Treat underlying cause
	*Antipsychotics (eg haloperidol, risperidone) may be useful for hyperactive delirium with psychotic features		*Antipsychotics (eg haloperidol, risperidone) may be useful for hyperactive delirium with psychotic features

Neil.m.young: Text replacement - "== " to "=="

2016-07-06T02:32:29Z

Text replacement - "== " to "=="

← Older revision		Revision as of 02:32, 6 July 2016
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	== Background==		==Background==
	*Also known as "acute toxic-metabolic encephalopathy"		*Also known as "acute toxic-metabolic encephalopathy"
	*Delirium vs. [[dementia]] vs. psych		*Delirium vs. [[dementia]] vs. psych

	== Clinical Features==		==Clinical Features==
	*Main cognitive impairment is that of inattention (vs memory in dementia)		*Main cognitive impairment is that of inattention (vs memory in dementia)
	*Generally develops over hours to days		*Generally develops over hours to days
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	A patient must possess both features 1 and 2 AND either 3 or 4 to meet delirium criteria		A patient must possess both features 1 and 2 AND either 3 or 4 to meet delirium criteria

	== Differential Diagnosis==		==Differential Diagnosis==
	{{AMS DDX}}		{{AMS DDX}}

	{{Psych DDX}}		{{Psych DDX}}

	== Diagnosis==		==Diagnosis==
	''Main goal is to find the underlying cause''		''Main goal is to find the underlying cause''
	{{AMS workup}}		{{AMS workup}}

	== Treatment==		==Treatment==
	*Treat underlying cause		*Treat underlying cause
	*Antipsychotics (eg haloperidol, risperidone) may be useful for hyperactive delirium with psychotic features		*Antipsychotics (eg haloperidol, risperidone) may be useful for hyperactive delirium with psychotic features

Neil.m.young: Text replacement - " ==" to "=="

2016-07-05T04:30:07Z

Text replacement - " ==" to "=="

← Older revision		Revision as of 04:30, 5 July 2016
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	== Background ==		== Background==
	*Also known as "acute toxic-metabolic encephalopathy"		*Also known as "acute toxic-metabolic encephalopathy"
	*Delirium vs. [[dementia]] vs. psych		*Delirium vs. [[dementia]] vs. psych

	== Clinical Features ==		== Clinical Features==
	*Main cognitive impairment is that of inattention (vs memory in dementia)		*Main cognitive impairment is that of inattention (vs memory in dementia)
	*Generally develops over hours to days		*Generally develops over hours to days
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	{{AMS workup}}		{{AMS workup}}

	== Treatment ==		== Treatment==
	*Treat underlying cause		*Treat underlying cause
	*Antipsychotics (eg haloperidol, risperidone) may be useful for hyperactive delirium with psychotic features		*Antipsychotics (eg haloperidol, risperidone) may be useful for hyperactive delirium with psychotic features

Ostermayer: Text replacement - "Category:Psych" to "Category:Psychiatry"

2016-03-22T16:03:00Z

Text replacement - "Category:Psych" to "Category:Psychiatry"

← Older revision		Revision as of 16:03, 22 March 2016
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	[[Category:Critical Care]]		[[Category:Critical Care]]
	[[Category:Neurology]]		[[Category:Neurology]]
	[[Category:~~Psych~~]]		[[Category:Psychiatry]]

Ostermayer: Text replacement - "Category:Neuro" to "Category:Neurology"

2016-03-22T14:14:32Z

Text replacement - "Category:Neuro" to "Category:Neurology"

← Older revision		Revision as of 14:14, 22 March 2016
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	[[Category:Critical Care]]		[[Category:Critical Care]]
	[[Category:~~Neuro~~]]		[[Category:Neurology]]
	[[Category:Psych]]		[[Category:Psych]]

← Older revision		Revision as of 09:26, 22 March 2026
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	*Extremely common: affects 10-30% of hospitalized elderly patients		*Extremely common: affects 10-30% of hospitalized elderly patients
	*Associated with increased mortality, prolonged hospitalization, and long-term cognitive decline		*Associated with increased mortality, prolonged hospitalization, and long-term cognitive decline
	*~~'''~~Key distinction from [[dementia]]:~~'''~~ Delirium is acute (hours-days), fluctuating, with inattention as primary deficit; dementia is chronic (months-years) with memory as primary deficit		*Key distinction from [[dementia]]: Delirium is acute (hours-days), fluctuating, with inattention as primary deficit; dementia is chronic (months-years) with memory as primary deficit

	==Clinical Features==		==Clinical Features==
	*~~'''~~Inattention~~'''~~ — hallmark feature (cannot maintain or shift attention appropriately)		*Inattention — hallmark feature (cannot maintain or shift attention appropriately)
	*Fluctuating course throughout the day		*Fluctuating course throughout the day
	*Develops over hours to days (acute onset)		*Develops over hours to days (acute onset)
	*~~'''~~Subtypes:~~'''~~		*Subtypes:
	**~~'''~~Hyperactive:~~'''~~ agitation, restlessness, hallucinations, combativeness (easier to diagnose)		**Hyperactive: agitation, restlessness, hallucinations, combativeness (easier to diagnose)
	**~~'''~~Hypoactive:~~'''~~ lethargy, decreased responsiveness, withdrawn (frequently missed — more common and more dangerous)		**Hypoactive: lethargy, decreased responsiveness, withdrawn (frequently missed — more common and more dangerous)
	**'''Mixed:''' alternating between hyperactive and hypoactive states		**'''Mixed:''' alternating between hyperactive and hypoactive states

	===Common Causes (mnemonic: DELIRIUM)===		===Common Causes (mnemonic: DELIRIUM)===
	*~~'''D'''rugs~~ (anticholinergics, opioids, benzodiazepines, steroids, polypharmacy)		*Drugs (anticholinergics, opioids, benzodiazepines, steroids, polypharmacy)
	*~~'''E'''lectrolyte~~ abnormalities, ~~'''E'''ndocrine~~ (thyroid, adrenal, glucose)		*Electrolyte abnormalities, Endocrine (thyroid, adrenal, glucose)
	*~~'''L'''ack~~ of drugs (withdrawal from alcohol, benzodiazepines, opioids)		*Lack of drugs (withdrawal from alcohol, benzodiazepines, opioids)
	*~~'''I'''nfection~~ (UTI, pneumonia, meningitis, sepsis)		*Infection (UTI, pneumonia, meningitis, sepsis)
	*~~'''R'''educed~~ sensory input (vision/hearing impairment, ICU environment)		*Reduced sensory input (vision/hearing impairment, ICU environment)
	*~~'''I'''ntracranial~~ pathology (stroke, hemorrhage, mass, seizure)		*Intracranial pathology (stroke, hemorrhage, mass, seizure)
	*~~'''U'''rinary~~ retention, constipation (especially in elderly)		*Urinary retention, constipation (especially in elderly)
	*~~'''M'''yocardial~~/pulmonary (MI, PE, hypoxia, CHF)		*Myocardial/pulmonary (MI, PE, hypoxia, CHF)

	===Confusion Assessment Method (CAM)===		===Confusion Assessment Method (CAM)===
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	==Evaluation==		==Evaluation==
	*~~'''~~Goal: identify and treat the underlying cause~~'''~~		*Goal: identify and treat the underlying cause
	{{AMS workup}}		{{AMS workup}}
	*Minimum: glucose, BMP, CBC, urinalysis, [[ECG]], [[CXR]]		*Minimum: glucose, BMP, CBC, urinalysis, [[ECG]], [[CXR]]
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	==Management==		==Management==
	*~~'''~~Treat the underlying cause~~'''~~ — this is the definitive management		*Treat the underlying cause — this is the definitive management
	*Non-pharmacologic measures first: reorientation, quiet environment, sleep-wake cycle preservation, mobilization, adequate hydration/nutrition, correct sensory deficits (glasses, hearing aids)		*Non-pharmacologic measures first: reorientation, quiet environment, sleep-wake cycle preservation, mobilization, adequate hydration/nutrition, correct sensory deficits (glasses, hearing aids)
	*~~'''~~Pharmacologic (for severe hyperactive delirium with safety concerns):~~'''~~		*Pharmacologic (for severe hyperactive delirium with safety concerns):
	**[[Haloperidol]] 0.5-2 mg IV/IM (start low in elderly)		**[[Haloperidol]] 0.5-2 mg IV/IM (start low in elderly)
	**[[Olanzapine]] 2.5-5 mg IM		**[[Olanzapine]] 2.5-5 mg IM