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
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
The April 14, 2004, issue of JAMA includes
an article about delirium that documents its relationship with death in intensive
New or worsening medical illnesses such as severe infections or
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
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.
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 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
Torpy JM, Lynm C, Glass RM. Delirium. JAMA. 2004;291(14):1794. doi:10.1001/jama.291.14.1794