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Delirium
Delirium is a disturbance of consciousness (awareness of the person's environment) characterized by altered or shifting mental status and inattention (reduced ability to focus, sustain, or shift attention). There are also changes in cognition (basic mental functions) such as memory impairment, disorientation to time or place, and language disturbance. There also may be disturbances of perception (accurate appreciation of the environment) such as hallucinations (seeing or hearing things that are not actually there), abnormal speech, abnormal movements (including tremors or picking at clothing), disruptive or violent behavior, and changes in emotions. To qualify for a diagnosis of delirium, the signs and symptoms must have a short onset (over a period of hours or days) and change over the course of the day. It is important to make a clear distinction between delirium and dementia (such as Alzheimer disease). Dementia is a disturbance in intellectual (thinking) functions that is usually gradually progressive over a long period.
Having delirium along with another medical illness can significantly increase a person's chance of dying from that illness. It is important for doctors to identify delirium so that it can be treated to improve the person's overall prognosis.
The April 14, 2004, issue of JAMA includes an article about delirium that documents its relationship with death in intensive care patients.
CAUSES OF DELIRIUM
- New or worsening medical illnesses such as severe infections or heart failure
- Medications, abused drugs, or poisons
- Drug withdrawal syndromes, such as delirium tremens (delirium from alcohol withdrawal)
- Psychiatric (mental) illnesses
- Severe pain, immobilization, or sleep deprivation
TREATMENTS FOR DELIRIUM
- Identifying and treating the underlying cause of delirium is essential.
- Supportive care, including mechanical ventilation and life-support medications, may be necessary.
- The need for all medications the patient is receiving should be assessed.
- Replacement of vitamin B should be considered for persons with alcoholism or who are malnourished.
- Antipsychotic medications may be used to reduce the symptoms of delirium.
- Benzodiazepines (anti-anxiety medications) may be used, particularly in cases of drug withdrawal syndromes.
- Protecting the patient and others may require the use of soft-restraint devices for a short time.
- Psychiatric assessment and management is helpful, particularly in cases of delirium not easily explainable by poison exposure, medication effects, or medical illness.
FOR MORE INFORMATION
INFORM YOURSELF
To find this and previous JAMA Patient Pages, go to the Patient Page link on JAMA's Web site at http://www.jama.com. Many are available in English and Spanish. A Patient Page on Alzheimer disease was published in the August 19, 1998, issue; and one on psychiatric illness in older adults was published in the June 7, 2000, issue.
Sources: American Psychiatric Association, National Institute of Mental Health, American Geriatrics Society, National Institute on Aging
The JAMA Patient Page is a public service of JAMA. The information and recommendations appearing on this page are appropriate in most instances, but they are not a substitute for medical diagnosis. For specific information concerning your personal medical condition, JAMA suggests that you consult your physician. This page may be photocopied noncommercially by physicians and other health care professionals to share with patients. Any other print or online reproduction is subject to AMA approval. To purchase bulk reprints, call 718/946-7424.
TOPIC: BRAIN DISORDERS
Janet M. Torpy, MD, Writer;
Cassio Lynm, MA, Illustrator;
Richard M. Glass, MD, Editor
JAMA. 2004;291:1794.
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