• Joseph Francis


The syndrome of delirium is one of the most common manifestations of acute illness or drug toxicity in older patients. Controversy surrounds the definition of delirium, because its manifestations are pleomorphic and its mechanisms poorly understood. The American Psychiatric Association, in its Diagnostic and Statistical Manual, fourth edition (DSM-IV), emphasizes four key features (Table 60.1). The first of these is disturbance of consciousness. Patients with delirium characteristically are less aware of their surroundings and have difficulty focusing, sustaining, or shifting attention. They become easily distracted and have difficulty following commands or maintaining a conversation. Accompanying delirium is an impairment of cognition and perception not attributable to prior or progressing dementia. This is manifested by memory problems, disorientation, misperceptions, hallucinations, and language problems (e.g., dysnomia, dysgraphia). The course of delirium is acute (defined as hours to days) and fluctuating (patients may be lucid during morning rounds yet combative or confused at night). Finally, delirium in an individual patient has one or more underlying medical etiologies.1


Femoral Neck Fracture Neuroleptic Malignant Syndrome Acute Confusional State Delirious Patient Elderly Medical Patient 
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© Springer Science+Business Media New York 1997

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  • Joseph Francis

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