Delirium is sudden severe
confusion and rapid changes in brain function that occur with physical or mental illness.
Acute confusional state; Acute brain syndrome
Causes, incidence, and risk factors
Delirium is most often caused by physical or mental illness and is usually temporary and reversible. Many disorders cause delirium, including conditions that deprive the brain of oxygen or other substances.
Delirium involves a quick change between mental states (for example, from
lethargy to agitation and back to lethargy).
Changes in alertness (usually more alert in the morning, less alert at night)
Changes in feeling (sensation) and perception
Changes in level of consciousness or awareness
Changes in movement (for example, may be slow moving or hyperactive)
Changes in sleep patterns, drowsiness
Confusion (disorientation) about time or place
Decrease in short-term memory and recall
Unable to remember events since delirium began (anterograde amnesia)
Unable to remember events before delirium (retrograde amnesia) Disrupted or wandering attention
Inability to think or behave with purpose
Problems concentrating Disorganized thinking
Speech that doesn't make sense (incoherent)
Inability to stop speech patterns or behaviors Emotional or personality changes
Movements triggered by changes in the nervous system (psychomotor restlessness) Signs and tests
The following tests may have abnormal results:
An exam of the nervous system (neurologic examination), including tests of feeling (sensation), thinking (cognitive function), and motor function
The following tests may also be done:
The goal of treatment is to control or reverse the cause of the symptoms. Treatment depends on the condition causing delirium. The person may need to stay in the hospital for a short time.
Stopping or changing medications that worsen confusion, or that are not necessary, may improve mental function. Substances and medicines that can worsen confusion include:
Analgesics, especially narcotics such as codeine, hydrocodone, morphine, or oxycodone
Central nervous system depressants
Disorders that contribute to confusion should be treated. These may include:
Treating medical and mental disorders often greatly improves mental function.
Medicines may be needed to control aggressive or agitated behaviors. These are usually started at very low dosages and adjusted as needed:
Antidepresssants (fluoxetine, citalopram), if depression is present
Dopamine blockers (haloperidol, quetiapine, or risperidone are most commonly used)
Sedatives (clonazepam or diazepam) in cases of delirium due to alcohol or sedative withdrawal
Some people with delirium may benefit from hearing aids, glasses, or
Other treatments that may be helpful:
Acute conditions that cause delirium may occur with
chronic disorders that cause dementia. Acute brain syndromes may be reversible by treating the cause.
Delirium often lasts only about 1 week, although it may take several weeks for mental function to return to normal levels. Full recovery is common.
Complications Loss of ability to function or care for self
Loss of ability to interact
Progression to stupor or coma
Side effects of medications used to treat the disorder Calling your health care provider
Call your health care provider if there is a rapid
change in mental status.
Treating the conditions that cause delirium can reduce its risk. In hospitalized patients, avoiding sedatives, staying still (immobilization), and bladder catheters, and using reality orientation programs will reduce the risk of delirium in those at high risk.
Mendez MF, Kremen SA. Delirium. In: Daroff RB, Fenichel GM, Jankovic J, Mazziotta JC, eds.
Bradley’s Neurology in Clinical Practice. 6th ed. Philadelphia, PA: Elsevier Saunders; 2012:chap 4.
Rudolph JL, Marcantonio ER. Delirium. In: Duthie EH Jr., Katz PR, Malone ML.
Practice of Geriatrics. 4th ed. Philadelphia, PA: Elsevier Saunders; 2007:chap 26.
Luc Jasmin, MD, PhD, Department of Neurosurgery, Cedars Sinai Medical Center, Los Angeles and Department of Anatomy, University of California, San Francisco, CA. Review provided by VeriMed Healthcare Network. Also reviewed by A.D.A.M. Health Solutions, Ebix, Inc., Editorial Team: David Zieve, MD, MHA, Bethanne Black, Stephanie Slon, and Nissi Wang.
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