by: Adilia Adris

Definition
An acute organic reaction (mental state) with the major disturbance, clouding of consciousness, concurrence with disturbances of attention, orientation, memory, perception, delusion, restlessness and agitation.
Short term confusion ( acute confusional state) and changes in levels of consciousness rujukan

Epidemiology
affects 15 to 50% of hospitalized people aged 70 or older. may occur at any age but is more common among older people. When delirium occurs in younger people, it is usually due to drug use or a life-threatening disorder.

Etiology
Systemic infection
Eg: any infection esp with high fever like malaria

Metabolic disturbances eg: hepatic failure, renal failure, dehydration, hypoxia, electrolyte imbalance Vitamin deficiency
Eg: B1, B12

Endocrine disease
Hypothyroidism Cushings syndrome

Intracranial causes
Trauma Tumor Abcess

Epilepsy
Subarachnoid haemorrhage

Drug intoxication
Anticonvulsants

Antimuscarinics
Anxiolytics Tricyclic antidepressant

Drug/ alcohol withdrawal Postoperative states Terminal illness

Subcategories ( DSM-IV)
Delirium
Substance induced General Medical Condition Multiple Etiologies Delirium Not Otherwise Specified

Substance withdrawal

Substance Intoxication

Symptoms (Key Features)

Altered consciousness with hyperarousal OR hypoarousal with agitation or apathy Memory impairment Disorientation Illogical speech Severe emotional lability perceptual disturbances -Hallucinations (auditory/visual/ Tactile) Fragmented sleep (sleep-wake cycle disturbance) Fluctuating levels of consciousness

Neurological symptoms
Incoordination Dysphasia Tremor Asterixis Ataxia Apraxia

Delirium due to a General Medical Condition

Disturbances of consciousness 2. A change in cognition or the development of a perceptual disturbance that is not better accouted for by preexisting, established, or evolving dementia. 3. The disturbance develops over a short period of time and tends to fluctuate during the course of the day 4. There is evidance from the history , physical examination , or laboratory findings that the disturbance is caused by the direct physiological consequences of a general medical condition.
1.

Substance intoxication delirium

Disturbance of consciousness with reduced ability to focus, sustain, or shift attention. 2. A change in cognition or the development of a perceptual disturbance that is not better accounted for by preexisting, established, or evolving dementia. 3. The disturbance develops over a short period of time and tends to fluctuate during the course of the day 4. There is evidence from the history , physical examination , or laboratory findings of either (1) or (2)
1.
The symptoms in criteria A and B developed during substance

intoxication Medication used is etiologically related to the disturbance

Substance withdrawal delirium

Disturbance of consciousness with reduced ability to focus, sustain, or shift attention. 2. A change in cognition or the development of a perceptual disturbance that is not better accounted for by preexisting, established, or evolving dementia. 3. The disturbance develops over a short period of time and tends to fluctuate during the course of the day 4. There is evidence from the history , physical examination , or laboratory findings that the symptoms in criteria A and B developed during , or shortly after , a withdrawal syndrome
1.

Delirium due to multiple etologies

Disturbance of consciousness with reduced ability to focus, sustain, or shift attention. 2. A change in cognition or the development of a perceptual disturbance that is not better accounted for by preexisting, established, or evolving dementia. 3. The disturbance develops over a short period of time and tends to fluctuate during the course of the day 4. There is evidence from the history , physical examination , or laboratory findings that the delirium has ore than one etiology
1.

Delirium Not Otherwise Specified

This category should be used to diagnose a delirium

that does not Meet the criteria for any of the specific types of delirium described in this section.

Patophysiology
Delirium is a result of the diffuse damage from the nerve tissue metabolism This can be seen from :

EEG study
generalized slowing activity of EEG slowing of the low amplitudo

Blood flow in the brain reduce usage of O2

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Differential Diagnosis
Dementia
Schizophrenia Psychosis

Depression

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DELIRIUM vs DEMENTIA?
Features Onset Course

Delirium
Acute Fluctuating

Dementia
Insidious Progressive

Duration
Consciousness Attention Psychomotor changes Reversibility

Days to weeks
Altered Impaired Increased or decreased Usually

Months to years
Clear Normal, except in severe dementia Often normal Rarely

Therapy

Treatment of underlying cause Medical care Drugs to control agitated and agressive behaviour
Antidepresssants (fluoxetine, citalopram) Dopamine blockers (haloperidol 5-10 mg/IM)

Sedatives (clonazepam or diazepam)

Thiamine

1.
2.

Symptomatic therapy Antipsychotic : Benzodiazepine : diazepam 10 mg/IM

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Complications
Loss of ability to function or care for self
Loss of ability to interact Progression to stupor or coma

Side effects of medications used to treat the disorder

Prognosis
often lasts only about 1 week, although it may take

several weeks for mental function to return to normal Full recovery is common.