JOURNAL READING

DELIRIUM
Supervisor:
dr. Iwan Sys, SpKJ

Abd hafid 201610401011006

MEDICAL PSYCHIATRY
MEDICAL FACULTY OF UNIVERSITY OF MUHAMMADIYAH
MALANG
2017
1
 BACKGROUND

Definition
Delirium is an acute, fluctuating syndrome of altered
attention, awareness, and cognition precipitated by an
underlying condition or event in vulnerable persons

commonly been referred to by other names,

including altered mental status, acute confusional
state, sundowning, encephalopathy, and acute
organic brain syndrome

2
INCIDENCE, PREVALENCE,
AND SIGNIFICANCE

3
RISK FACTORS

4
PATHOPHYSIOLOGY
 CLINICAL MANIFESTATIONS

The fundamental psychopathological features of delirium are :

 DIAGNOSTIC TESTING

Delirium evaluation begins with a thorough physical examination with

particular attention paid to findings suggestive of metabolic
derangement, infection, and neurologic focality.
All older persons presenting with delirium require a basic workup
including :
Complete blood count,
Measurement of electrolyte levels,
Renal and liver panel,
Urinalysis,
Electrocardiography
Computed tomography of the head for patients presenting with new
focal neurologic deficits, history of head trauma, or fever associated
with encephalopathy.
Magnetic resonance imaging (MRI) more sensitive in evaluating for
space occupying lesions, white matter disease processes, and new
ischemic stroke as causes of delirium.
DIFFERENTIAL DIAGNOSIS
 TREATMENT

In some distressed
patients with hyperactive
symptoms, such as
agitation or
hallucinations:
haloperidol or olanzapine
can be used cautiously
(lowest effective dose for
less than 1 week)
Risperidone (0.51mg)
and quetiapine (25
50mg) are reasonable
alternatives
TREATMENT

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 NONPHARMACOLOGICAL
INTERVENTIONS

These interventions, dependent on the provision of high-

quality nursing care, are effective in reducing the incidence,
severity, and duration of delirium.
These non pharmacological interventions include promoting
day activity, maintaining quite well-lit environment, staff
continuity, avoiding room and bed changes, providing
hearing and visual aids, encouraging personal items, limiting
visits especially for hyperactive delirium patients, remove
noxious stimuli (e.g., catheters, pumps, etc.), limiting
medical monitoring and testing (e.g., measuring blood
pressure, temperature)
 PREVENTION

Assessment for and prevention of delirium should occur at

admission to the hospital and throughout the stay.
Studies have demonstrated that a multicomponent
nonpharmacologic approach is highly effective and reduces the
number and duration of episodes of delirium.
Nonpharmacologic prevention strategies consist of orientation
and therapeutic activities, early and recurrent mobilization,
minimizing the use of psychoactive medications, promoting
normal sleep-wake cycles, providing easy access to adaptive
equipment for sensory impairment (e.g., glasses, hearing aids),
and preventing dehydration.
 PROGNOSIS

Delirium in hospitalized older persons was associated with

increased mortality, regardless of confounders such as age, sex,
and comorbidities.
The mortality rate associated with delirium in patients in the
hospital is estimated to be 14.5% to 37%.
Prognosis hinges on the subtype and duration of delirium
Hypoactive delirium has a worse prognosis.
A prolonged state of delirium is associated with poorer
outcomes, including functional decline, dementia, and death.
 DELIRIUM IN OLDER PERSONS:
EVALUATION AND MANAGEMENT
Virginia B. Kalish, Md, National Capitol Consortium, Fort Belvoir,
Virginia
Joseph E. Gillham, Md, Robinson Health Clinic, Fort Bragg, North
Carolina
Brian K. Unwin, Md, Carilion Clinic, Roanoke, Virginia

American Academy of Family Physicians. 2014;90(3):150-158

http://www. aafp.org/
 DELIRIUM: PRESENTATION,
EPIDEMIOLOGY, AND DIAGNOSTIC
EVALUATION (PART 1)

Colin J. Harrington, MD; Kalya Vardi, MD

Rhode Island Medical Journal. June 2014 :18- 23

http://www.rimed.org/