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 sudden shifts 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 December 24/31, 2008, issue of JAMA includes an article about agitation and delirium at the end of life. This Patient Page is based on one previously published in the April 14, 2004, issue of JAMA.
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
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 (antianxiety medications) may be used, particularly in cases of drug withdrawal syndromes.
If no other treatments are effective and the patient is at clear risk of harm to self or others, soft restraints may be needed for a short time.
Psychiatric assessment and management are important, particularly in cases of delirium not easily explainable by poison exposure, medication effects, or medical illness.
American Psychiatric Associationhttp://www.psych.org
Brain Dysfunction in Critically Ill Patientshttp://www.icudelirium.org
National Institute of Mental Healthhttp://www.nimh.nih.gov
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 dementia was published in the November 19, 2008, 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. To purchase bulk reprints, call 312/464-0776.
TOPIC: BRAIN DISORDERS
Torpy JM, Burke AE, Glass RM. Delirium. JAMA. 2008;300(24):2936. doi:10.1001/jama.300.24.2936