Abstract
Delirium (acute brain failure or acute confusional state) is a clinical syndrome that is always due to a medical condition, usually more than one. A correct diagnosis of delirium is needed to offer treatment directed at the underlying cause(s). Hallmark symptoms of delirium (inattention, altered consciousness, disordered thinking, fluctuating mental state) can be overshadowed by psychosis and catatonia which can lead to a missed delirium diagnosis. This chapter reviews the clinical diagnosis of a delirium, its medical work-up, treatment (antipsychotics including intravenous haloperidol), and prevention. Psychiatric conditions that can be confused with a delirium or predispose to a delirium are discussed.
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References
Quote Investigator. Available from: https://quoteinvestigator.com/2013/12/02/confuse-them/. Accessed on 7/1/2019.
Webster R, Holroyd S. Prevalence of psychotic symptoms in delirium. Psychosomatics. 2000;41:519–22.
Karmacharya R, England ML, Ongur D. Delirious mania: clinical features and treatment response. J Affect Disord. 2008;109:312–6.
Mash DC. Excited delirium and sudden death: a syndromal disorder at the extreme end of the neuropsychiatric continuum. Front Physiol. 2016;7:435.
Freudenreich O, Menza M. Zolpidem-related delirium: a case report. J Clin Psychiatry. 2000;61:449–50.
Stern TA, Celano CM, Gross AF, Huffman JC, Freudenreich O, Kontos N, et al. The assessment and management of agitation and delirium in the general hospital. Prim Care Companion J Clin Psychiatry. 2010;12:PCC 09r00938.
Inouye SK, van Dyck CH, Alessi CA, Balkin S, Siegal AP, Horwitz RI. Clarifying confusion: the confusion assessment method. A new method for detection of delirium. Ann Intern Med. 1990;113:941–8.
Oldham MA, Flanagan NM, Khan A, Boukrina O, Marcantonio ER. Responding to ten common delirium misconceptions with best evidence: an educational review for clinicians. J Neuropsychiatry Clin Neurosci. 2018;30:51–7.
Inouye SK, Westendorp RG, Saczynski JS. Delirium in elderly people. Lancet. 2014;383:911–22.
Wilson JE, Carlson R, Duggan MC, Pandharipande P, Girard TD, Wang L, et al. Delirium and catatonia in critically ill patients: the delirium and catatonia prospective cohort investigation. Crit Care Med. 2017;45:1837–44.
Sidhu KS, Balon R, Ajluni V, Boutros NN. Standard EEG and the difficult-to-assess mental status. Ann Clin Psychiatry. 2009;21:103–8.
Leentjens AF, Rundell J, Rummans T, Shim JJ, Oldham R, Peterson L, et al. Delirium: an evidence-based medicine (EBM) monograph for psychosomatic medicine practice, commissioned by the Academy of Psychosomatic Medicine (APM) and the European Association of Consultation Liaison Psychiatry and Psychosomatics (EACLPP). J Psychosom Res. 2012;73:149–52.
Kishi T, Hirota T, Matsunaga S, Iwata N. Antipsychotic medications for the treatment of delirium: a systematic review and meta-analysis of randomised controlled trials. J Neurol Neurosurg Psychiatry. 2016;87:767–74.
Cassem NH, Murray GB. Delirious patients. In: Cassem NH, Stern TA, Rosenbaum JF, Jellinek MS, editors. Massachusetts General Hospital handbook of general hospital psychiatry. 4th ed. St. Louis: Mosby – Year Book, Inc.; 1997. p. 101–22.
Menza MA, Murray GB, Holmes VF, Rafuls WA. Decreased extrapyramidal symptoms with intravenous haloperidol. J Clin Psychiatry. 1987;48:278–80.
Yu A, Wu S, Zhang Z, Dening T, Zhao S, Pinner G, et al. Cholinesterase inhibitors for the treatment of delirium in non-ICU settings. Cochrane Database Syst Rev. 2018;6:CD012494.
Jeste DV, Caligiuri MP, Paulsen JS, Heaton RK, Lacro JP, Harris MJ, et al. Risk of tardive dyskinesia in older patients. A prospective longitudinal study of 266 outpatients. Arch Gen Psychiatry. 1995;52:756–65.
Oh ES, Fong TG, Hshieh TT, Inouye SK. Delirium in older persons: advances in diagnosis and treatment. JAMA. 2017;318:1161–74.
Neufeld KJ, Yue J, Robinson TN, Inouye SK, Needham DM. Antipsychotic medication for prevention and treatment of delirium in hospitalized adults: a systematic review and meta-analysis. J Am Geriatr Soc. 2016;64:705–14.
Additional Resources
Book Chapter
Caplan JP. Delirious patients. In: Stern TA, Freudenreich O, Smith FA, Fricchione GL, Rosenbaum JF, editors. Massachusetts General Hospital handbook of general hospital psychiatry. 7th ed. Edinburgh: Elsevier; 2018. p. 83–93. – From my department’s book on General Hospital Psychiatry. The CL service at MGH has extensive experience with the management of delirium, and this chapter contains detailed instructions about how to optimally treat a delirium, including IV haloperidol.
Articles
Inouye SK, Westendorp RG, Saczynski JS. Delirium in elderly people. Lancet. 2014;383:911–22. – Excellent conceptual overview of delirium by one of the pioneers in delirium research.
Oldham MA, Flanagan NM, Khan A, Boukrina O, Marcantonio ER. Responding to ten common delirium misconceptions with best evidence: an educational review for clinicians. J Neuropsychiatry Clin Neurosci. 2018;30:51–7. – Readable and practical guide for clinicians that corrects commonly held misconceptions about delirium.
Hall W, Zador D, et al. Lancet. 1997;349:1897–900. – Remains one of the best articles on the basic principles of alcohol withdrawal, which I did not cover in this chapter.
Stern TA, Celano CM, Gross AF, Huffman JC, Freudenreich O, Kontos N, et al. The assessment and management of agitation and delirium in the general hospital. Prim Care Companion J Clin Psychiatry. 2010;12:PCC 09r00938. – A clinical article about the diagnosis and treatment of agitation and delirium in the general medical hospital.
Wu YC, Tseng PT, Tu YK, Hsu CY, Liang CS, Yeh TC, et al. Association of delirium response and safety of pharmacological interventions for the management and prevention of delirium: a network meta-analysis. JAMA Psychiat. 2019;76:526–35. – If you like network meta-analyses, here are the results from one: haloperidol plus lorazepam worked best for the treatment of delirium, ramelteon for its prevention.
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Freudenreich, O. (2020). Delirium. In: Psychotic Disorders. Current Clinical Psychiatry. Humana, Cham. https://doi.org/10.1007/978-3-030-29450-2_3
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DOI: https://doi.org/10.1007/978-3-030-29450-2_3
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