Delirium is sudden severe confusion and rapid changes in brain function that occur with physical or mental illness.
Alternative NamesAcute confusional state; Acute brain syndrome
Causes, incidence, and risk factorsDelirium 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.
Causes include:
Delirium involves a quick change between mental states (for example, from lethargy to agitation and back to lethargy).
Symptoms include:
The following tests may have abnormal results:
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. Diagnosis and care should take place in a pleasant, comfortable, nonthreatening, physically safe environment. 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 significantly. Medications that may worsen confusion include:
Disorders that contribute to confusion should be treated. These may include:
Treating medical and mental disorders often greatly improves mental function.
Medications may be needed to control aggressive or agitated behaviors. These are usually started at very low doses and adjusted as needed.
Medications include:
Some people with delirium may benefit from hearing aids, glasses, or cataract surgery.
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.
ComplicationsCall your health care provider if there is a rapid change in mental status.
PreventionTreating 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.
ReferencesInouye Sk. Delirium and other mental status problems in the older patient. In: Goldman L, Ausiello D, eds. Cecil Medicine. 23rd ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 26.