Delirium is sudden severe confusion due to rapid changes in brain function that occur with physical or mental illness.
Acute confusional state; Acute brain syndrome
Delirium is most often caused by physical or mental illness, and is usually temporary and reversible. Many disorders cause delirium. Often, these do not allow the brain to get oxygen or other substances. They may also cause dangerous chemicals (toxins) to build up in the brain. Delirium is common in the intensive care unit (ICU), especially in older adults.
Delirium involves a quick change between mental states (for example, from lethargy to agitation and back to lethargy).
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. The person may need to stay in the hospital for a short time.
Stopping or changing medicines that worsen confusion, or that are not necessary, may improve mental function.
Disorders that contribute to confusion should be treated. These may include:
Treating medical and mental disorders often greatly improves mental function.
Medicines may be needed to control aggressive or agitated behaviors. These are usually started at very low dosages and adjusted as needed.
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 long-term (chronic) disorders that cause dementia. Acute brain syndromes may be reversible by treating the cause.
Delirium often lasts about 1 week. It may take several weeks for mental function to return to normal. Full recovery is common, but depends on the underlying cause of the delirium.
Problems that may result from delirium include:
Call your health care provider if there is a rapid change in mental status.
Treating the conditions that cause delirium can reduce its risk. In hospitalized people, avoiding or using a low dosage of sedatives, prompt treatment of metabolic disorders and infections, and using reality orientation programs will reduce the risk of delirium in those at high risk.
Inouye SK. Delirium or acute mental status change in the older patient. In: Goldman L, Schafer AI, eds. Goldman-Cecil Medicine. 25th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 28.
Irwin SA, Pirrello RD, Hirst JM, Buckholz GT, Ferris FD. Clarifying delirium management: practical, evidenced-based, expert recommendations for clinical practice. J Palliat Med. 2013;16(4):423-435. PMID: 23480299 www.ncbi.nlm.nih.gov/pubmed/23480299.
Mendez MF, Padilla CR. Delirium. In: Daroff RB, Jankovic J, Mazziotta JC, Pomeroy SL, eds. Bradley's Neurology in Clinical Practice. 7th ed. Philadelphia, PA: Elsevier; 2016:chap 4.
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. 2017;30(1):51-57 PMID: 28876970 www.ncbi.nlm.nih.gov/pubmed/28876970.