Materiały źródłowe

• #1 Delirium – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK470399/

  Delirium is a clinical syndrome that usually develops in the elderly. It is characterized by an alteration of attention, consciousness, and cognition, with a reduced ability to focus, sustain or shift attention. […] The diagnosis is often missed, especially the hypoactive type, due to its subtle clinical manifestation. […] The diagnosis of delirium is clinically based. […] The presence of delirium requires features 1 and 2 and either 3 or 4: Acute change in mental status with a fluctuating course; Inattention (reduced ability to sustain attention and follow conversations). […] The primary treatment for delirium is based on prevention and non-pharmacologic interventions because there are no FDA-approved medications for the treatment or prevention of delirium. […] The Hospital Elder Life Program (HELP) has been shown to reduce the incidence of delirium in elderly patients, falls, and overall healthcare costs. […] Pharmacological agents are used in cases of substance withdrawal-associated delirium, delirium at the end of life, and cases of hyperactive delirium where the patient’s behavior is a threat to themselves or others. […] The overall prognosis for patients with delirium is guarded.

• #2 Diagnosis of delirium: a practical approach | Practical Neurology

  https://pn.bmj.com/content/23/3/192

  Delirium is an acute disorder of fluctuating attention and awareness with cardinal features that allow it to be positively distinguished from other causes of an acute confusional state. […] We describe a framework for diagnosing delirium, noting the need to consider certain caveats and differential diagnoses. […] Delirium is a clinical diagnosis where a thorough history and clinical examination are much more helpful diagnostically than any single test or combination of tests. […] Delirium is not a diagnosis of exclusion: it has its own cardinal features of fluctuations, prominent inattentiveness with other cognitive deficits, changes in awareness and visual hallucinations, and temporal association with a provoking trigger (and improvement with treatment or removal of that trigger). […] We emphasise that delirium is a clinical diagnosis where thoroughness of history-taking and clinical examination are diagnostically much more helpful than any single or combination of paraclinical test(s).

• #3 Assessment of delirium – Differential diagnosis of symptoms | BMJ Best Practice

  https://bestpractice.bmj.com/topics/en-gb/241

  The Diagnostic and Statistical Manual of Mental Disorders (DSM-5-TR) notes that in order to be diagnosed with delirium, a patient must show all 4 of the following features. […] The disturbance develops over a short period of time (usually hours to days), represents an acute change from baseline, and tends to fluctuate during the course of the day. […] Three clinical subtypes of delirium have been identified. […] The prevalence of delirium in the community is believed to be 1% to 2%, a figure that increases to 14% for patients aged 85 years. […] Prevalence of delirium ranges from 10% to 40% in older hospitalised patients. […] Delirium affects up to 30% of people on medical wards. […] Prevalence ranges from 14% to 24% in the emergency department, 15% to 53% for postoperative patients, and 70% to 87% for intensive care patients.

• #4 Delirium: What It Is, Symptoms, Treatment & Types

  https://my.clevelandclinic.org/health/diseases/15252-delirium

  Delirium is a type of confusion that happens when the combined strain of illnesses, environmental circumstances or other risk factors disrupts your brain function. Its more common in adults over 65. This condition is serious and can cause long-term or permanent problems, especially with delays in treatment. However, its also often preventable. […] Delirium is a fast-developing type of confusion that affects your ability to focus your attention and awareness. It happens when theres widespread disruption in brain activity, usually because of a combination of factors. Delirium is more common in medical settings, such as during long hospital stays or in long-term care facilities. […] Research indicates that delirium affects between 18% and 35% of people admitted to a hospital for inpatient care. Up to 60% of people in an intensive care unit may experience delirium. However, researchers suspect delirium is more common than statistics indicate. The available research suggests that between 1 in 3 and 2 in 3 delirium cases go undiagnosed.

• #5 Delirium – PsychDB

  https://www.psychdb.com/cl/1-delirium

  Delirium is a serious neuropsychiatric syndrome characterized by an acute confusional state with global impairments in attention and cognition. […] The community prevalence of delirium is low, between 1 to 2%, but increases with age, rising to 14% in individuals older than 85 years. […] The prevalence is 10% to 30% in older individuals presenting to emergency departments, where the delirium is a result of a medical illness. […] Up to 40% of cases of delirium are preventable. […] A disturbance in attention (i.e. – reduced ability to direct, focus, sustain, and shift attention) and awareness (reduced orientation to the environment). […] The disturbance develops over a short period of time (usually hours to a few days), represents a change from baseline attention and awareness, and tends to fluctuate in severity during the course of a day.

• #6 DSM-5 criteria for delirium – Primary Care Notebook

  https://primarycarenotebook.com/pages/geriatric-medicine/dsm-5-criteria-for-delirium

  A. A disturbance in attention (i.e., reduced ability to direct, focus, sustain, and shift attention) and awareness (reduced orientation to the environment). […] B. The disturbance develops over a short period of time (usually hours to a few days), represents a change from baseline attention and awareness, and tends to fluctuate in severity during the course of a day. […] C. An additional disturbance in cognition (e.g., memory deficit, disorientation, language, visuospatial ability, or perception). […] D. The disturbances in Criteria A and C are not explained by another preexisting, established, or evolving neurocognitive disorder and do not occur in the context of a severely reduced level of arousal, such as coma. […] E. There is evidence from the history, physical examination, or laboratory findings that the disturbance is a direct physiological consequence of another medical condition, substance intoxication or withdrawal (i.e., due to a drug of abuse or to a medication), or exposure to a toxin, or is due to multiple etiologies.

• #7 Diagnosis and Tests for Delirium | American Geriatrics Society | HealthInAging.org

  https://www.healthinaging.org/a-z-topic/delirium/tests

  If you think that an older adult may have delirium, let a healthcare professional know. Have the person evaluated as soon as possible. […] Healthcare professionals diagnose delirium by observing a person and testing their state of mind. The professionals can use a simple set of tests and standard questions. […] The healthcare provider may use an assessment tool such as the Confusion Assessment Method (also known as CAM), for high-risk older adults. […] Delirium can have the same symptoms as dementia. This can make it hard to make a diagnosis. […] Delirium develops far more quickly than dementia. When the behavior or thinking of a person with dementia quickly gets much worse, the cause is likely to be delirium. […] Delirium is still treatable and preventable in persons with dementia. Seek medical attention as quickly as possible.

• #8 Delirium – symptoms, diagnosis and treatment | Alzheimer’s Society

  https://www.alzheimers.org.uk/get-support/daily-living/delirium

  Delirium is a serious but often treatable condition that can happen suddenly to someone who is unwell. […] Delirium is not the same as dementia, but they can look similar to someone who doesn’t know the person well. […] The most important part of delirium being diagnosed is someone noticing that the person is not themselves, or that they’re acting strangely. […] It’s very common for delirium to be missed or thought to be something else. […] Using a screening tool, such as a 4AT (the 4 A’s test), can help to identify delirium more accurately. […] Once a person has been diagnosed with delirium, healthcare professionals will try to work out what is causing it. […] Delirium is common, particularly among older people in hospital. […] Delirium is treated by resolving the health problems that have caused it. […] For many people the symptoms of delirium usually improve in a few days, once the underlying causes have been treated. […] Having prolonged and severe delirium over several weeks can increase a person’s risk of developing dementia.

• #9 Assessment of delirium – Differential diagnosis of symptoms | BMJ Best Practice

  https://bestpractice.bmj.com/topics/en-gb/241

  The Diagnostic and Statistical Manual of Mental Disorders (DSM-5-TR) notes that in order to be diagnosed with delirium, a patient must show all 4 of the following features. […] The disturbance develops over a short period of time (usually hours to days), represents an acute change from baseline, and tends to fluctuate during the course of the day. […] Three clinical subtypes of delirium have been identified. […] The prevalence of delirium in the community is believed to be 1% to 2%, a figure that increases to 14% for patients aged 85 years. […] Prevalence of delirium ranges from 10% to 40% in older hospitalised patients. […] Delirium affects up to 30% of people on medical wards. […] Prevalence ranges from 14% to 24% in the emergency department, 15% to 53% for postoperative patients, and 70% to 87% for intensive care patients.

• #10 Delirium – PsychDB

  https://www.psychdb.com/cl/1-delirium

  Delirium is a serious neuropsychiatric syndrome characterized by an acute confusional state with global impairments in attention and cognition. […] The community prevalence of delirium is low, between 1 to 2%, but increases with age, rising to 14% in individuals older than 85 years. […] The prevalence is 10% to 30% in older individuals presenting to emergency departments, where the delirium is a result of a medical illness. […] Up to 40% of cases of delirium are preventable. […] A disturbance in attention (i.e. – reduced ability to direct, focus, sustain, and shift attention) and awareness (reduced orientation to the environment). […] The disturbance develops over a short period of time (usually hours to a few days), represents a change from baseline attention and awareness, and tends to fluctuate in severity during the course of a day.

• #11 Assessment of delirium – Differential diagnosis of symptoms | BMJ Best Practice

  https://bestpractice.bmj.com/topics/en-gb/241

  The Diagnostic and Statistical Manual of Mental Disorders (DSM-5-TR) notes that in order to be diagnosed with delirium, a patient must show all 4 of the following features. […] The disturbance develops over a short period of time (usually hours to days), represents an acute change from baseline, and tends to fluctuate during the course of the day. […] Three clinical subtypes of delirium have been identified. […] The prevalence of delirium in the community is believed to be 1% to 2%, a figure that increases to 14% for patients aged 85 years. […] Prevalence of delirium ranges from 10% to 40% in older hospitalised patients. […] Delirium affects up to 30% of people on medical wards. […] Prevalence ranges from 14% to 24% in the emergency department, 15% to 53% for postoperative patients, and 70% to 87% for intensive care patients.

• #12 Assessment of delirium – Differential diagnosis of symptoms | BMJ Best Practice

  https://bestpractice.bmj.com/topics/en-gb/241

  The Diagnostic and Statistical Manual of Mental Disorders (DSM-5-TR) notes that in order to be diagnosed with delirium, a patient must show all 4 of the following features. […] The disturbance develops over a short period of time (usually hours to days), represents an acute change from baseline, and tends to fluctuate during the course of the day. […] Three clinical subtypes of delirium have been identified. […] The prevalence of delirium in the community is believed to be 1% to 2%, a figure that increases to 14% for patients aged 85 years. […] Prevalence of delirium ranges from 10% to 40% in older hospitalised patients. […] Delirium affects up to 30% of people on medical wards. […] Prevalence ranges from 14% to 24% in the emergency department, 15% to 53% for postoperative patients, and 70% to 87% for intensive care patients.

• #13 Assessment of delirium – Differential diagnosis of symptoms | BMJ Best Practice

  https://bestpractice.bmj.com/topics/en-gb/241

  The Diagnostic and Statistical Manual of Mental Disorders (DSM-5-TR) notes that in order to be diagnosed with delirium, a patient must show all 4 of the following features. […] The disturbance develops over a short period of time (usually hours to days), represents an acute change from baseline, and tends to fluctuate during the course of the day. […] Three clinical subtypes of delirium have been identified. […] The prevalence of delirium in the community is believed to be 1% to 2%, a figure that increases to 14% for patients aged 85 years. […] Prevalence of delirium ranges from 10% to 40% in older hospitalised patients. […] Delirium affects up to 30% of people on medical wards. […] Prevalence ranges from 14% to 24% in the emergency department, 15% to 53% for postoperative patients, and 70% to 87% for intensive care patients.

• #14 Screening for Delirium | Palliative in Practice | Center to Advance Palliative Care

  https://www.capc.org/blog/screening-for-delirium-what-clinicians-should-know/

  Delirium is a significant source of suffering and distress for patients and loved ones. […] Delirium is especially prevalent among patients with serious illness, with studies demonstrating rates of delirium as high as 74% in inpatient palliative care units. […] Given these consequences and the accompanying fear, anxiety, and loss of dignity that delirium causes, it is crucial for palliative care clinicians to have a solid understanding of delirium: what it is, how it presents, and how it is evaluated, prevented, and treated. […] Delirium is a neuropsychiatric condition classically characterized by the acute onset of waxing and waning fluctuations in attention and level of arousal. […] Delirium is diagnosed based on clinical presentation, focusing on the timing of symptom onset, associated symptoms, and thorough mental status and cognitive exams. […] While delirium itself is diagnosed clinically, arriving at a diagnosis is often the first step, followed by a close exploration of potential triggers.

• #15 Delirium: What It Is, Symptoms, Treatment & Types

  https://my.clevelandclinic.org/health/diseases/15252-delirium

  Delirium is a type of confusion that happens when the combined strain of illnesses, environmental circumstances or other risk factors disrupts your brain function. Its more common in adults over 65. This condition is serious and can cause long-term or permanent problems, especially with delays in treatment. However, its also often preventable. […] Delirium is a fast-developing type of confusion that affects your ability to focus your attention and awareness. It happens when theres widespread disruption in brain activity, usually because of a combination of factors. Delirium is more common in medical settings, such as during long hospital stays or in long-term care facilities. […] Research indicates that delirium affects between 18% and 35% of people admitted to a hospital for inpatient care. Up to 60% of people in an intensive care unit may experience delirium. However, researchers suspect delirium is more common than statistics indicate. The available research suggests that between 1 in 3 and 2 in 3 delirium cases go undiagnosed.

• #16 Diagnosis: Delirium | Improvement Exchange | Clinical Excellence Queensland | Queensland Health

  https://test.clinicalexcellence.qld.gov.au/improvement-exchange/diagnosis-delirium

  Studies show the prevalence of delirium in hospital inpatients (65 years) ranges from 11-42 per cent, however only 12-35 per cent of these cases of delirium are recognised by clinicians. […] Misdiagnosis of delirium results in missed opportunities for treatment, including safe discharge planning. […] Early diagnosis and clinician management of delirium has also been shown to improve patient outcomes and non pharmacological prevention strategies when delirium is diagnosed can reduce inpatient falls and reduce healthcare costs. […] Delirium is a treatable and preventable condition and early identification, management and prevention represents significant cost savings opportunities for hospitals. […] It is important to note that satisfying DCCS Standards 4 to 7 is dependent on effective diagnostic of delirium.

• #17 Delirium: a guide for the general physician

  https://pmc.ncbi.nlm.nih.gov/articles/PMC6329570/

  Delirium describes a sudden onset change in mental status of fluctuating course. This is a state of altered consciousness characterised chiefly by inattention or lack of arousal, but can also include new impairment of language, perception and behaviour. […] Delirium is varied in its presentation, and can be categorised by the psychomotor profile as: hyperactive type (overly vigilant, agitated, often wandersome), hypoactive type (sedate or withdrawn) or mixed types. […] Despite its high prevalence, delirium often goes undetected and undetected delirium is associated with the highest mortality. […] Delirium heralds high risk of falls, longer inpatient stay, post-discharge institutionalisation, accelerated and lasting cognitive decline, and higher mortality. […] Delirium is both common and dangerous, but current evidence suggests it is also preventable in about one third of cases, hence the growing emphasis on the adoption of multicomponent delirium prevention interventions.

• #18 Assessment of delirium – Differential diagnosis of symptoms | BMJ Best Practice

  https://bestpractice.bmj.com/topics/en-gb/241

  Delirium is an acute, fluctuating change in mental status, with inattention, disorganised thinking, and altered levels of consciousness. […] It is a potentially life-threatening disorder characterised by high morbidity and mortality. Guidelines address recognition, risk factors, and treatment for delirium. […] Mortality for those diagnosed with delirium in hospital is twice that of patients with similar medical conditions without delirium and rises as high as 14% within 1 month of diagnosis. […] Delirium occurs in 20% to 25% of hospitalisations annually and is the most common hospital-related complication in the US. […] Despite its frequency, delirium is frequently under-recognised given the fluctuating nature of symptoms and an overall under-appreciation of its significance by healthcare providers.

• #19 Delirium Clinical Presentation: History, Physical, Causes

  https://emedicine.medscape.com/article/288890-clinical

  The diagnosis of delirium is clinical. No laboratory test can diagnose delirium. Obtaining a thorough history is essential. […] Because delirious patients often are confused and unable to provide accurate information, getting a detailed history from family, caregivers, and nursing staff is particularly important. […] Delirium always should be suspected when (a new onset) or an acute or subacute deterioration in behavior, cognition, or function occurs, especially in patients who are elderly, demented, or depressed. […] Delirium is mistaken for dementia or depression, especially when patients are quiet or withdrawn. However, by Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision (DSM-5-TR) criteria, dementia cannot be diagnosed with certainty when delirium is present.

• #20 Diagnosis, prevention and management of delirium: spot it, stop it, treat it | BJPsych Advances | Cambridge Core

  https://www.cambridge.org/core/journals/bjpsych-advances/article/diagnosis-prevention-and-management-of-delirium-spot-it-stop-it-treat-it/3F58BA5AE303B426E9FE72817D847F29

  The current standard diagnostic criteria for delirium are outlined in DSM-5-TR and ICD-11. […] In terms of preferred screening tools, variability is commonplace. […] The 4 A’s Test (4AT) may be the screening tool of choice in the general medical setting. […] A key benefit of the 4AT is that it is quick and simple to administer and a range of health and social care practitioners can carry out the screen without specialised training. […] Delirium can be the initial signal of a medical emergency. […] Risk factors for delirium among ICU patients have been well studied and several risk factors can apply universally to populations in any clinical setting, such as older age, frailty, functional disabilities and high burden of coexisting conditions. […] Multicomponent approaches have the strongest evidence for the prevention of delirium, compared with any single-component interventions.

• #21 Delirium – Knowledge @ AMBOSS

  https://www.amboss.com/us/knowledge/delirium/

  Delirium is diagnosed clinically, based on either the DSM 5 or Confusion Assessment Method (CAM) criteria. […] Delirium should be considered a medical emergency until proven otherwise; it can be a sign of severe underlying pathology and is associated with increased mortality. […] Diagnosis of delirium requires features 1 and 2 PLUS either feature 3 or 4. […] Diagnosis of delirium is clinical. Identify the underlying precipitating factors for DELIRIUM: Drugs, Electrolyte abnormalities, Lack of medication (withdrawal), Infection, Reduced sensorial input, Intracranial pathology, Urinary retention or fecal impaction, Myocardial and pulmonary disease.

• #22 DSM-5 criteria for delirium – Primary Care Notebook

  https://primarycarenotebook.com/pages/geriatric-medicine/dsm-5-criteria-for-delirium

  A. A disturbance in attention (i.e., reduced ability to direct, focus, sustain, and shift attention) and awareness (reduced orientation to the environment). […] B. The disturbance develops over a short period of time (usually hours to a few days), represents a change from baseline attention and awareness, and tends to fluctuate in severity during the course of a day. […] C. An additional disturbance in cognition (e.g., memory deficit, disorientation, language, visuospatial ability, or perception). […] D. The disturbances in Criteria A and C are not explained by another preexisting, established, or evolving neurocognitive disorder and do not occur in the context of a severely reduced level of arousal, such as coma. […] E. There is evidence from the history, physical examination, or laboratory findings that the disturbance is a direct physiological consequence of another medical condition, substance intoxication or withdrawal (i.e., due to a drug of abuse or to a medication), or exposure to a toxin, or is due to multiple etiologies.

• #23 Delirium: a guide for the general physician

  https://pmc.ncbi.nlm.nih.gov/articles/PMC6329570/

  Delirium describes a sudden onset change in mental status of fluctuating course. This is a state of altered consciousness characterised chiefly by inattention or lack of arousal, but can also include new impairment of language, perception and behaviour. […] Delirium is varied in its presentation, and can be categorised by the psychomotor profile as: hyperactive type (overly vigilant, agitated, often wandersome), hypoactive type (sedate or withdrawn) or mixed types. […] Despite its high prevalence, delirium often goes undetected and undetected delirium is associated with the highest mortality. […] Delirium heralds high risk of falls, longer inpatient stay, post-discharge institutionalisation, accelerated and lasting cognitive decline, and higher mortality. […] Delirium is both common and dangerous, but current evidence suggests it is also preventable in about one third of cases, hence the growing emphasis on the adoption of multicomponent delirium prevention interventions.

• #24 Diagnosis and Treatment of Terminal Delirium | Palliative Care Network of Wisconsin

  https://www.mypcnow.org/fast-fact/diagnosis-and-treatment-of-terminal-delirium/

  Diagnosis and Treatment of Terminal Delirium […] This Fast Fact reviews assessment and management issues in terminal delirium. […] Delirium can be characterized by a hyperactive/agitated state, a hypoactive state, or a mixture of the two. The hallmark of delirium is an acute change in mentation and attention with either disorganized thinking, easy distractibility, or a fluctuating level of consciousness. […] „Terminal delirium” is not a distinct diagnosis, although it is a commonly used phrase. It implies delirium in a patient in the final days/weeks of life, where treatment of the underlying cause is impossible, impractical, or not consistent with the goals of care. […] Patients need a focused assessment, including orientation to person, place, time, medical situation, and treatment options to better characterize confusion.

• #25 Delirium – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK470399/

  Delirium is a clinical syndrome that usually develops in the elderly. It is characterized by an alteration of attention, consciousness, and cognition, with a reduced ability to focus, sustain or shift attention. […] The diagnosis is often missed, especially the hypoactive type, due to its subtle clinical manifestation. […] The diagnosis of delirium is clinically based. […] The presence of delirium requires features 1 and 2 and either 3 or 4: Acute change in mental status with a fluctuating course; Inattention (reduced ability to sustain attention and follow conversations). […] The primary treatment for delirium is based on prevention and non-pharmacologic interventions because there are no FDA-approved medications for the treatment or prevention of delirium. […] The Hospital Elder Life Program (HELP) has been shown to reduce the incidence of delirium in elderly patients, falls, and overall healthcare costs. […] Pharmacological agents are used in cases of substance withdrawal-associated delirium, delirium at the end of life, and cases of hyperactive delirium where the patient’s behavior is a threat to themselves or others. […] The overall prognosis for patients with delirium is guarded.

• #26 Hypoactive Delirium: Differential Diagnosis, Evaluation, and Treatment

  https://www.psychiatrist.com/pcc/hypoactive-delirium-differential-diagnosis-evaluation-treatment/

  Have you ever wondered what is meant by the term hypoactive delirium? […] The classification of delirium subtypes characterized by phenotypic differences in motor activity was first suggested by Lipowski in 1983; this concept was later reviewed by Liptzin and Levkoff, in 1992, in their empirical study of delirium subtypes. […] Individuals with hypoactive delirium are drowsy, lethargic, or sluggish (in the absence of sedative-hypnotics, pain medications, or sedating psychotropic medications); they never fully awaken, repeatedly fall back to sleep midsentence, and need to be provided with frequent prompts by staff. […] The recognition of hypoactive delirium should prompt the search for its underlying etiologies, with initial attention paid to life-threatening or emergent causes. […] Hypoactive delirium is typically manifest by unawareness, decreased alertness, sparse or slow speech, lethargy, slowed movements, staring, and apathy. […] Optimal management of hypoactive delirium involves a timely and targeted multipronged approach (involving pharmacologic and nonpharmacologic interventions) that addresses the underlying etiologies and precipitating factors.

• #27 Delirium – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/delirium/diagnosis-treatment/drc-20371391

  A health care provider can diagnose delirium based on medical history and tests of mental status. The provider also will consider factors that may have caused the disorder. An exam may include: […] The provider starts by testing awareness, attention and thinking. This may be done by talking with the person. Or it may be done with tests or screenings. Information from family members or caregivers can be helpful. […] A physical exam checks for signs of health problems or disease. A neurological exam checks vision, balance, coordination and reflexes. This can help determine if a stroke or another disease is causing the delirium. […] The health care provider may order blood, urine and other tests. Brain-imaging tests may be used when a diagnosis can’t be made with other information.

• #28 Delirium: What It Is, Symptoms, Treatment & Types

  https://my.clevelandclinic.org/health/diseases/15252-delirium

  Delirium and dementia arent the same thing. Delirium involves waxing and waning symptoms, meaning they get better and worse. Dementia refers to a steady decline in thinking ability. […] The main symptom of delirium is confusion. That means you have trouble with: Focusing or shifting your attention when necessary. Thinking and concentrating. Remembering facts, events, people, etc. Staying aware of your surroundings. […] A healthcare provider diagnoses delirium based on a combination of methods. These include: A physical exam. A neurological exam. Observing your behavior and any symptoms you show. Talking to you and asking questions. A review of your medical history. Lab testing. […] Theres no specific treatment or medication for delirium. Instead, healthcare providers will treat causes and contributing factors they can identify.

• #29 Delirium Clinical Presentation: History, Physical, Causes

  https://emedicine.medscape.com/article/288890-clinical

  The diagnosis of delirium is clinical. No laboratory test can diagnose delirium. Obtaining a thorough history is essential. […] Because delirious patients often are confused and unable to provide accurate information, getting a detailed history from family, caregivers, and nursing staff is particularly important. […] Delirium always should be suspected when (a new onset) or an acute or subacute deterioration in behavior, cognition, or function occurs, especially in patients who are elderly, demented, or depressed. […] Delirium is mistaken for dementia or depression, especially when patients are quiet or withdrawn. However, by Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision (DSM-5-TR) criteria, dementia cannot be diagnosed with certainty when delirium is present.

• #30 Delirium – Symptoms and causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/delirium/symptoms-causes/syc-20371386

  Delirium can often be traced to one or more factors. […] Health care providers may rely on input from a family member or caregiver to diagnose the disorder. […] If a relative, friend or someone in your care shows symptoms of delirium, talk to the person’s health care provider. Your input about symptoms, typical thinking and usual abilities will be important for a diagnosis. […] Tests for dementia shouldn’t be done during a delirium episode because the results could be misleading.

• #31 Delirium – PsychDB

  https://www.psychdb.com/cl/1-delirium

  Doctors and nurses do a poor job of identifying delirium. […] The Confusion Assessment Method (CAM) is a standardized evidence-based tool that allows clinicians to identify and recognize delirium quickly and accurately in both clinical and research settings. […] Obtaining a good history is key and should be the first step when seeing a patient with delirium. […] Delirium should be thought of as a symptom, not a diagnosis. […] One of the prevailing theories of the pathogenesis of delirium is acetylcholine deficiency. […] Acetylcholine plays an extensive role in attention and consciousness, and deficiencies are thought to result in the core symptoms of both hypoactive and hyperactive delirium. […] In non-ICU setting patients, always start with non-pharmacological interventions first, both in the prevention and management of delirium.

• #32 Delirium – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/delirium/diagnosis-treatment/drc-20371391

  A health care provider can diagnose delirium based on medical history and tests of mental status. The provider also will consider factors that may have caused the disorder. An exam may include: […] The provider starts by testing awareness, attention and thinking. This may be done by talking with the person. Or it may be done with tests or screenings. Information from family members or caregivers can be helpful. […] A physical exam checks for signs of health problems or disease. A neurological exam checks vision, balance, coordination and reflexes. This can help determine if a stroke or another disease is causing the delirium. […] The health care provider may order blood, urine and other tests. Brain-imaging tests may be used when a diagnosis can’t be made with other information.

• #33 Delirium – Neurologic Disorders – MSD Manual Professional Edition

  https://www.msdmanuals.com/professional/neurologic-disorders/delirium-and-dementia/delirium

  Delirium, particularly in older patients, is often overlooked by clinicians. […] History is obtained by interviewing family members, caregivers, and friends. […] Examination should focus on vital signs, hydration status, potential foci for infection, and neurologic examination. […] Testing usually includes CT or MRI of the head, tests for suspected infection, and measurement of electrolytes. […] Treatment of underlying disorder and removal of exacerbating factors is essential. […] Correcting the cause and removing exacerbating factors may result in resolution of delirium. […] Antipsychotic medications are sometimes used to treat severe agitation, but their routine use is not recommended. […] Approximately 30 to 50% of hospitalized patients with delirium die within 1 year. […] Treat the cause of delirium and provide supportive care; manage agitation with general measures and sometimes medications when necessary.

• #34 Delirium Clinical Presentation: History, Physical, Causes

  https://emedicine.medscape.com/article/288890-clinical

  To make an accurate diagnosis, periodic application of diagnostic criteria such as CAM or DSM-5-TR criteria and knowledge of the patient’s baseline mental status is imperative. […] Gaps in the medical record such as once daily cognitive assessment or no formal assessments on the hallmarks of delirium (attention span and fluctuation) may make diagnosing the condition more difficult. […] A simple cognitive test like the Mini-Cog can be a predictor of inhospital delirium. […] The Confusion Assessment Method for the Intensive Care Unit (CAM-ICU) offers the clinician the opportunity to identify delirium in critical care patients, especially patients on mechanical ventilation. […] Another instrument that can be used in ICU settings is the Intensive Care Delirium Screening Checklist (ICDSC).

• #35

  https://journals.lww.com/co-supportiveandpalliativecare/fulltext/2014/09000/delirium_diagnosis,_screening_and_management.18.aspx

  Much higher prevalence rates have been reported in palliative care settings, yet the level of recognition and documentation here too is remarkably poor. […] Collectively, delirium recognition problems require solutions at many levels. […] The ideal screening tool should have a high level of sensitivity, be brief and easy to use with minimal training. […] Recent validation and other delirium screening tool studies are summarized in Table 1. […] Although the CAM has been validated in a palliative care population, its sensitivity is very much dependent on user training. […] Studies are needed to rigorously evaluate the benefits and potential harms of screening in relation to multiple outcomes such as medical intervention requirements, preventive strategies, delirium reversibility, care needs and economic burden.

• #36 Delirium Clinical Presentation: History, Physical, Causes

  https://emedicine.medscape.com/article/288890-clinical

  To make an accurate diagnosis, periodic application of diagnostic criteria such as CAM or DSM-5-TR criteria and knowledge of the patient’s baseline mental status is imperative. […] Gaps in the medical record such as once daily cognitive assessment or no formal assessments on the hallmarks of delirium (attention span and fluctuation) may make diagnosing the condition more difficult. […] A simple cognitive test like the Mini-Cog can be a predictor of inhospital delirium. […] The Confusion Assessment Method for the Intensive Care Unit (CAM-ICU) offers the clinician the opportunity to identify delirium in critical care patients, especially patients on mechanical ventilation. […] Another instrument that can be used in ICU settings is the Intensive Care Delirium Screening Checklist (ICDSC).

• #37 How accurate is the CAM-ICU tool for the diagnosis of delirium in adult patients admitted to critical care units? | Cochrane

  https://www.cochrane.org/CD013126/DEMENTIA_how-accurate-cam-icu-tool-diagnosis-delirium-adult-patients-admitted-critical-care-units

  We included 25 studies with a total of 2817 participants. CAM-ICU correctly identified patients with delirium about 78% of the time. The test was better at identifying those without delirium, giving correct results about 95% of the time. […] The CAM-ICU tool may have a role in the early identification of delirium, in adult patients hospitalized in intensive care units, including those on mechanical ventilation, when non-specialized, properly trained clinical personnel apply the CAM-ICU. The test is most useful for exclusion of delirium. The test may miss a proportion of patients with incident delirium, therefore in situations where detection of all delirium cases is desirable, it may be best to repeat the test or combine CAM-ICU with another assessment. […] Delirium is an underdiagnosed clinical syndrome typified by an acute alteration of mental state. It is an important problem in critical care and intensive care units (ICU) due to its high prevalence and its association with adverse outcomes.

• #38 Diagnosis, prevention and management of delirium: spot it, stop it, treat it | BJPsych Advances | Cambridge Core

  https://www.cambridge.org/core/journals/bjpsych-advances/article/diagnosis-prevention-and-management-of-delirium-spot-it-stop-it-treat-it/3F58BA5AE303B426E9FE72817D847F29

  The current standard diagnostic criteria for delirium are outlined in DSM-5-TR and ICD-11. […] In terms of preferred screening tools, variability is commonplace. […] The 4 A’s Test (4AT) may be the screening tool of choice in the general medical setting. […] A key benefit of the 4AT is that it is quick and simple to administer and a range of health and social care practitioners can carry out the screen without specialised training. […] Delirium can be the initial signal of a medical emergency. […] Risk factors for delirium among ICU patients have been well studied and several risk factors can apply universally to populations in any clinical setting, such as older age, frailty, functional disabilities and high burden of coexisting conditions. […] Multicomponent approaches have the strongest evidence for the prevention of delirium, compared with any single-component interventions.

• #39 Diagnosis of delirium in hospitals can be improved by the 4 A’s test

  https://evidence.nihr.ac.uk/alert/diagnosis-of-delirium-in-hospitals-can-be-improved-by-the-4-as-test/

  Diagnosis of delirium in hospitals can be improved by the 4 As test. A new shorter test for delirium appears helpful in assessing older people in hospital who may have the condition. A normal score on the 4 As test effectively rules out delirium while an abnormal score is reasonably useful for detecting the condition. People detected by the test would still need a full assessment to confirm the diagnosis. Delirium can be easily mistaken for dementia. This combined with lengthy assessment tools, have meant that in primary and acute care settings there can be difficulties in diagnosis. This study aimed to assess how far this relatively new tool has been incorporated into practice as well as its diagnostic utility. An abnormal 4 As test score had a specificity of 95% and a sensitivity of 76% for reference standard delirium. In this population, the 4 As test achieved a positive predictive value of 66% and a negative predictive value of 96%. The 4 As test, which is shorter than existing full screening tools, appears helpful when used in the diagnostic pathway for people with suspected delirium. However, this study has also highlighted that until staff awareness is improved and there are clearer lines of responsibility for delirium assessment, the opportunity this test provides for better diagnosis could be missed. […] The consequences of missed delirium both for individual patients and the NHS are serious and expensive. Anything that increases delirium awareness and improves detection will have clear benefits.

• #40 Delirium diagnosis defined by cluster analysis of symptoms versus diagnosis by DSM and ICD criteria: diagnostic accuracy study | BMC Psychiatry | Full Text

  https://bmcpsychiatry.biomedcentral.com/articles/10.1186/s12888-016-0878-6

  We also measured inter-rater reliability of each system when applied by two evaluators from distinct disciplines. […] The DRS-R98 is an ideal tool to evaluate the delirium phenotype because it was developed based on delirium symptom characteristics rather than any particular (a priori) diagnostic system. […] It has been subsequently translated and revalidated in countries outside of the U.S. […] It was designed to evaluate the breadth and severity of known delirium characteristics and enabled delineation of its three core domains (cognitive, circadian, higher order thinking), its noncore aspects, cognitive alterations, motor subtypes, subsyndromal phenotype and longitudinal course of episodes. […] We used four classification systems: the DSM-5, DSM-IV and DSM-III-R editions and the ICD-10 for research.

• #41 Delirium Clinical Presentation: History, Physical, Causes

  https://emedicine.medscape.com/article/288890-clinical

  To make an accurate diagnosis, periodic application of diagnostic criteria such as CAM or DSM-5-TR criteria and knowledge of the patient’s baseline mental status is imperative. […] Gaps in the medical record such as once daily cognitive assessment or no formal assessments on the hallmarks of delirium (attention span and fluctuation) may make diagnosing the condition more difficult. […] A simple cognitive test like the Mini-Cog can be a predictor of inhospital delirium. […] The Confusion Assessment Method for the Intensive Care Unit (CAM-ICU) offers the clinician the opportunity to identify delirium in critical care patients, especially patients on mechanical ventilation. […] Another instrument that can be used in ICU settings is the Intensive Care Delirium Screening Checklist (ICDSC).

• #42 Delirium Clinical Presentation: History, Physical, Causes

  https://emedicine.medscape.com/article/288890-clinical

  The severity of delirium in the ICU can be estimated by the Delirium Detection Scale (DDS). […] A 2012 meta-analysis showed a sensitivity of 75.5% and specificity of 95.8% for CAM-ICU, whereas sensitivity and specificity for the ICDSC were 80.1% and 74.6%, respectively. […] These results suggest the CAM-ICU is one of the most specific bedside tests that can be used to diagnose delirium in ICU patients.

• #43 Delirium – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/delirium/diagnosis-treatment/drc-20371391

  A health care provider can diagnose delirium based on medical history and tests of mental status. The provider also will consider factors that may have caused the disorder. An exam may include: […] The provider starts by testing awareness, attention and thinking. This may be done by talking with the person. Or it may be done with tests or screenings. Information from family members or caregivers can be helpful. […] A physical exam checks for signs of health problems or disease. A neurological exam checks vision, balance, coordination and reflexes. This can help determine if a stroke or another disease is causing the delirium. […] The health care provider may order blood, urine and other tests. Brain-imaging tests may be used when a diagnosis can’t be made with other information.

• #44 Delirium | Diagnosis & Treatment | Freedmans Health

  https://freedmanshealth.org/diseases-conditions/diagnosis-treatment/delirium/

  A healthcare provider diagnoses delirium based on a combination of methods. These include: […] There aren’t any lab or diagnostic tests that can diagnose delirium directly. However, a variety of tests can play a role in searching for possible causes.

• #45 Delirium Workup: Laboratory Studies, Imaging Studies, Other Tests

  https://emedicine.medscape.com/article/288890-workup

  Laboratory tests that may be helpful for diagnosis of delirium include the following: […] Serum marker for delirium: The calcium-binding protein S-100 B could be a serum marker of delirium. Higher levels are seen in patients with delirium when compared to patients without delirium. […] In delirium, generally, slowing of the posterior dominant rhythm and increased generalized slow-wave activity are observed on electroencephalogram (EEG) recordings. […] Lumbar puncture is indicated when CNS infection is suspected as a cause of delirium or when the source for the systemic infection cannot be determined. […] Electrocardiogram is used to diagnose ischemic and arrhythmic causes.

• #46 Delirium Nursing Diagnosis and Care Management – Nurseslabs

  https://nurseslabs.com/delirium/

  Delirium is an acute neuropsychiatric syndrome characterized by rapid-onset confusion, altered consciousness, and impaired cognitive function. It often results from underlying medical conditions, substance use, or medication effects. […] Delirium is a disturbance of consciousness and a change in cognition that develop rapidly over a short period (DSM-IV-TR). […] Delirium is an acute and reversible condition that often occurs as a result of an underlying medical condition, substance intoxication or withdrawal, or medication side effects. […] When delirium is diagnosed or suspected, the underlying causes should be sought and treated. […] Laboratory tests that may be helpful for diagnosis include the following: Complete blood cell count with differential. Helpful to diagnose infection and anemia.

• #47 Delirium – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/delirium/diagnosis-treatment/drc-20371391

  A health care provider can diagnose delirium based on medical history and tests of mental status. The provider also will consider factors that may have caused the disorder. An exam may include: […] The provider starts by testing awareness, attention and thinking. This may be done by talking with the person. Or it may be done with tests or screenings. Information from family members or caregivers can be helpful. […] A physical exam checks for signs of health problems or disease. A neurological exam checks vision, balance, coordination and reflexes. This can help determine if a stroke or another disease is causing the delirium. […] The health care provider may order blood, urine and other tests. Brain-imaging tests may be used when a diagnosis can’t be made with other information.

• #48 Delirium – Neurologic Disorders – MSD Manual Professional Edition

  https://www.msdmanuals.com/professional/neurologic-disorders/delirium-and-dementia/delirium

  Delirium, particularly in older patients, is often overlooked by clinicians. […] History is obtained by interviewing family members, caregivers, and friends. […] Examination should focus on vital signs, hydration status, potential foci for infection, and neurologic examination. […] Testing usually includes CT or MRI of the head, tests for suspected infection, and measurement of electrolytes. […] Treatment of underlying disorder and removal of exacerbating factors is essential. […] Correcting the cause and removing exacerbating factors may result in resolution of delirium. […] Antipsychotic medications are sometimes used to treat severe agitation, but their routine use is not recommended. […] Approximately 30 to 50% of hospitalized patients with delirium die within 1 year. […] Treat the cause of delirium and provide supportive care; manage agitation with general measures and sometimes medications when necessary.

• #49 Delirium Workup: Laboratory Studies, Imaging Studies, Other Tests

  https://emedicine.medscape.com/article/288890-workup

  Laboratory tests that may be helpful for diagnosis of delirium include the following: […] Serum marker for delirium: The calcium-binding protein S-100 B could be a serum marker of delirium. Higher levels are seen in patients with delirium when compared to patients without delirium. […] In delirium, generally, slowing of the posterior dominant rhythm and increased generalized slow-wave activity are observed on electroencephalogram (EEG) recordings. […] Lumbar puncture is indicated when CNS infection is suspected as a cause of delirium or when the source for the systemic infection cannot be determined. […] Electrocardiogram is used to diagnose ischemic and arrhythmic causes.

• #50 Delirium in older adults: Diagnosis, prevention, and treatment | British Columbia Medical Journal

  https://bcmj.org/articles/delirium-older-adults-diagnosis-prevention-and-treatment

  The diagnosis of delirium requires a patient interview, a physical examination, cognitive testing, and a review of the medical chart and any collateral information. […] Screening tools are an attractive adjunct to clinical assessment, especially if time is limited. […] A diagnosis is suggested by acute-onset confusion and inattention plus disordered thinking or altered level of consciousness. […] Because a multitude of underlying causes may be involved, a broad diagnostic approach is needed and clinicians should keep an open mind about the possibility of more than one contributing medical problem. […] The investigations ordered will depend on the assessment, but generally include an electrocardiogram, a complete blood count with differential, and testing for electrolytes (including calcium, phosphate, and magnesium), liver enzymes, thyroid function, troponin, and vitamin B12.

• #51 5. Differential Diagnosis for Delirium | ATrain Education

  https://www.atrainceu.com/content/5-differential-diagnosis-delirium-0

  Delirium can be difficult to differentiate from other conditions like dementia or depression because many of the symptoms are similar. […] The hallmark difference between delirium and other conditions is its rapid onset, its fluctuating course, and the patients inability to hold attention. […] In delirium, the level of consciousness can fluctuate, whereas it is steady in dementia. […] Delirious patients have impaired orientation and are acutely confused; in those with mild dementia, orientation might be normal but will slowly progress to disorientation. […] Sleep/wake cycles are disturbed in those experiencing delirium, but patients with dementia may begin with normal cycles that slowly degrade as the disease progresses. […] Delirium: First, Rule It Out […] 4. Screening Tools for Delirium […] 5. Differential Diagnosis for Delirium […] 6. Strategies for Addressing Delirium.

• #52 Delirium | MedlinePlus

  https://medlineplus.gov/delirium.html

  Delirium is a mental state in which you are confused, disoriented, and not able to think or remember clearly. It usually starts suddenly. It is often temporary and treatable. […] How is delirium diagnosed? Your health care provider may use many tools to make a diagnosis: A medical history, which includes asking about your symptoms, Physical and neurological exams, Mental status testing, which checks for problems with your thinking and alertness, Lab and diagnostic imaging tests. […] Delirium and dementia have similar symptoms, so it can be hard to tell them apart. You can also have both at the same time. The differences between them are that: Delirium starts suddenly and can cause hallucinations. It is mainly a problem with attention and staying alert. The symptoms may get better or worse and can last for hours or weeks.

• #53 5. Differential Diagnosis for Delirium | ATrain Education

  https://www.atrainceu.com/content/5-differential-diagnosis-delirium-0

  Delirium can be difficult to differentiate from other conditions like dementia or depression because many of the symptoms are similar. […] The hallmark difference between delirium and other conditions is its rapid onset, its fluctuating course, and the patients inability to hold attention. […] In delirium, the level of consciousness can fluctuate, whereas it is steady in dementia. […] Delirious patients have impaired orientation and are acutely confused; in those with mild dementia, orientation might be normal but will slowly progress to disorientation. […] Sleep/wake cycles are disturbed in those experiencing delirium, but patients with dementia may begin with normal cycles that slowly degrade as the disease progresses. […] Delirium: First, Rule It Out […] 4. Screening Tools for Delirium […] 5. Differential Diagnosis for Delirium […] 6. Strategies for Addressing Delirium.

• #54 Differential diagnosis – depression, delirium and dementia | health.vic.gov.au

  https://www.health.vic.gov.au/older-people-in-hospital/cognition-dementia-delirium-and-depression/differential-diagnosis-depression-delirium-and-dementia

  Delirium must be differentiated from Dementia with Lewy Bodies. […] High rates of delirium and depression are reported in people with dementia so these conditions may co-exist and each needs to be addressed. […] Differentiating depression from dementia and delirium requires knowing the characteristic features of each condition and establishing the patients premorbid cognitive status and mood. […] Delays in investigating and treating underlying reasons for cognitive impairment, or initiating inappropriate treatment, can have serious consequences for an older persons health and wellbeing whilst they are in hospital and on discharge. […] It is important to differentiate delirium from Dementia with Lewy Bodies (DLB). These conditions can appear identical, however, haloperidol, which may sometimes be used to manage delirium symptoms, can cause severe movement disturbances and can even be fatal to some patients with DLB. The presence of parkinsonism helps in differentiating DLB from delirium.

• #55 Delirium – Neurologic Disorders – MSD Manual Professional Edition

  https://www.msdmanuals.com/professional/neurologic-disorders/delirium-and-dementia/delirium

  Delirium is an acute, transient, usually reversible, fluctuating disturbance in attention, cognition, and consciousness level. […] Diagnosis is clinical; laboratory and imaging testing can help identify the cause. […] Delirium is sometimes called acute confusional state or toxic-metabolic encephalopathy. […] Delirium and dementia are distinct cognitive disorders but are sometimes difficult to distinguish. […] Delirium often develops in patients with dementia and is called delirium superimposed on dementia (DSD). […] Delirium is characterized primarily by difficulty focusing, maintaining, or shifting attention (inattention). […] Mental status examination is required for patients with any sign of cognitive impairment. […] Standard diagnostic criteria to confirm delirium include disturbance in attention and awareness, development over a short period of time, and acute change in cognition.

• #56 Diagnosis and Tests for Delirium | American Geriatrics Society | HealthInAging.org

  https://www.healthinaging.org/a-z-topic/delirium/tests

  If you think that an older adult may have delirium, let a healthcare professional know. Have the person evaluated as soon as possible. […] Healthcare professionals diagnose delirium by observing a person and testing their state of mind. The professionals can use a simple set of tests and standard questions. […] The healthcare provider may use an assessment tool such as the Confusion Assessment Method (also known as CAM), for high-risk older adults. […] Delirium can have the same symptoms as dementia. This can make it hard to make a diagnosis. […] Delirium develops far more quickly than dementia. When the behavior or thinking of a person with dementia quickly gets much worse, the cause is likely to be delirium. […] Delirium is still treatable and preventable in persons with dementia. Seek medical attention as quickly as possible.

• #57 Differential diagnosis – depression, delirium and dementia | health.vic.gov.au

  https://www.health.vic.gov.au/older-people-in-hospital/cognition-dementia-delirium-and-depression/differential-diagnosis-depression-delirium-and-dementia

  Delirium must be differentiated from Dementia with Lewy Bodies. […] High rates of delirium and depression are reported in people with dementia so these conditions may co-exist and each needs to be addressed. […] Differentiating depression from dementia and delirium requires knowing the characteristic features of each condition and establishing the patients premorbid cognitive status and mood. […] Delays in investigating and treating underlying reasons for cognitive impairment, or initiating inappropriate treatment, can have serious consequences for an older persons health and wellbeing whilst they are in hospital and on discharge. […] It is important to differentiate delirium from Dementia with Lewy Bodies (DLB). These conditions can appear identical, however, haloperidol, which may sometimes be used to manage delirium symptoms, can cause severe movement disturbances and can even be fatal to some patients with DLB. The presence of parkinsonism helps in differentiating DLB from delirium.

• #58 Delirium – Wikipedia

  https://en.wikipedia.org/wiki/Delirium

  Delirium may be difficult to diagnose without first establishing a person’s usual mental function or 'cognitive baseline’. […] Diagnostically, delirium encompasses both the syndrome of acute confusion and its underlying organic process known as an acute encephalopathy. […] The DSM-5-TR criteria are often the standard for diagnosing delirium clinically. […] Guidelines recommend that delirium should be diagnosed consistently when present. […] Delirium detection in general acute care settings can be assisted by the use of validated delirium screening tools. […] In the ICU, international guidelines recommend that every person admitted gets checked for delirium every day using a validated clinical tool. […] There are conditions that might have similar clinical presentations to those seen in delirium. […] Delirium is often confused with schizophrenia, psychosis, organic brain syndromes, and more, because of similar signs and symptoms of these disorders.

• #59 Delirium Clinical Presentation: History, Physical, Causes

  https://emedicine.medscape.com/article/288890-clinical

  The diagnosis of delirium is clinical. No laboratory test can diagnose delirium. Obtaining a thorough history is essential. […] Because delirious patients often are confused and unable to provide accurate information, getting a detailed history from family, caregivers, and nursing staff is particularly important. […] Delirium always should be suspected when (a new onset) or an acute or subacute deterioration in behavior, cognition, or function occurs, especially in patients who are elderly, demented, or depressed. […] Delirium is mistaken for dementia or depression, especially when patients are quiet or withdrawn. However, by Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision (DSM-5-TR) criteria, dementia cannot be diagnosed with certainty when delirium is present.

• #60 Differential diagnosis – depression, delirium and dementia | health.vic.gov.au

  https://www.health.vic.gov.au/older-people-in-hospital/cognition-dementia-delirium-and-depression/differential-diagnosis-depression-delirium-and-dementia

  Delirium must be differentiated from Dementia with Lewy Bodies. […] High rates of delirium and depression are reported in people with dementia so these conditions may co-exist and each needs to be addressed. […] Differentiating depression from dementia and delirium requires knowing the characteristic features of each condition and establishing the patients premorbid cognitive status and mood. […] Delays in investigating and treating underlying reasons for cognitive impairment, or initiating inappropriate treatment, can have serious consequences for an older persons health and wellbeing whilst they are in hospital and on discharge. […] It is important to differentiate delirium from Dementia with Lewy Bodies (DLB). These conditions can appear identical, however, haloperidol, which may sometimes be used to manage delirium symptoms, can cause severe movement disturbances and can even be fatal to some patients with DLB. The presence of parkinsonism helps in differentiating DLB from delirium.

• #61 How accurate is the CAM-ICU tool for the diagnosis of delirium in adult patients admitted to critical care units? | Cochrane

  https://www.cochrane.org/CD013126/DEMENTIA_how-accurate-cam-icu-tool-diagnosis-delirium-adult-patients-admitted-critical-care-units

  We included 25 studies with a total of 2817 participants. CAM-ICU correctly identified patients with delirium about 78% of the time. The test was better at identifying those without delirium, giving correct results about 95% of the time. […] The CAM-ICU tool may have a role in the early identification of delirium, in adult patients hospitalized in intensive care units, including those on mechanical ventilation, when non-specialized, properly trained clinical personnel apply the CAM-ICU. The test is most useful for exclusion of delirium. The test may miss a proportion of patients with incident delirium, therefore in situations where detection of all delirium cases is desirable, it may be best to repeat the test or combine CAM-ICU with another assessment. […] Delirium is an underdiagnosed clinical syndrome typified by an acute alteration of mental state. It is an important problem in critical care and intensive care units (ICU) due to its high prevalence and its association with adverse outcomes.

• #62 Delirium – Wikipedia

  https://en.wikipedia.org/wiki/Delirium

  Delirium may be difficult to diagnose without first establishing a person’s usual mental function or 'cognitive baseline’. […] Diagnostically, delirium encompasses both the syndrome of acute confusion and its underlying organic process known as an acute encephalopathy. […] The DSM-5-TR criteria are often the standard for diagnosing delirium clinically. […] Guidelines recommend that delirium should be diagnosed consistently when present. […] Delirium detection in general acute care settings can be assisted by the use of validated delirium screening tools. […] In the ICU, international guidelines recommend that every person admitted gets checked for delirium every day using a validated clinical tool. […] There are conditions that might have similar clinical presentations to those seen in delirium. […] Delirium is often confused with schizophrenia, psychosis, organic brain syndromes, and more, because of similar signs and symptoms of these disorders.

• #63 Delirium Clinical Presentation: History, Physical, Causes

  https://emedicine.medscape.com/article/288890-clinical

  To make an accurate diagnosis, periodic application of diagnostic criteria such as CAM or DSM-5-TR criteria and knowledge of the patient’s baseline mental status is imperative. […] Gaps in the medical record such as once daily cognitive assessment or no formal assessments on the hallmarks of delirium (attention span and fluctuation) may make diagnosing the condition more difficult. […] A simple cognitive test like the Mini-Cog can be a predictor of inhospital delirium. […] The Confusion Assessment Method for the Intensive Care Unit (CAM-ICU) offers the clinician the opportunity to identify delirium in critical care patients, especially patients on mechanical ventilation. […] Another instrument that can be used in ICU settings is the Intensive Care Delirium Screening Checklist (ICDSC).

• #64 How accurate is the CAM-ICU tool for the diagnosis of delirium in adult patients admitted to critical care units? | Cochrane

  https://www.cochrane.org/CD013126/DEMENTIA_how-accurate-cam-icu-tool-diagnosis-delirium-adult-patients-admitted-critical-care-units

  To determine the diagnostic accuracy of the CAM-ICU for the diagnosis of delirium in adult patients in critical care units. […] We included diagnostic studies enrolling adult ICU patients assessed using the CAM-ICU tool, regardless of language or publication status and reporting sufficient data on delirium diagnosis for the construction of 2 x 2 tables. Eligible studies evaluated the diagnostic performance of the CAM-ICU versus a clinical reference standard based on any iteration of the Diagnostic and Statistical Manual of Mental Disorders (DSM) criteria applied by a clinical expert. […] Overall, we estimated a pooled sensitivity of 0.78 (95% confidence interval (CI) 0.72 to 0.83) and a pooled specificity of 0.95 (95% CI 0.92 to 0.97).

• #65 Screening for Delirium | Palliative in Practice | Center to Advance Palliative Care

  https://www.capc.org/blog/screening-for-delirium-what-clinicians-should-know/

  Delirium is a significant source of suffering and distress for patients and loved ones. […] Delirium is especially prevalent among patients with serious illness, with studies demonstrating rates of delirium as high as 74% in inpatient palliative care units. […] Given these consequences and the accompanying fear, anxiety, and loss of dignity that delirium causes, it is crucial for palliative care clinicians to have a solid understanding of delirium: what it is, how it presents, and how it is evaluated, prevented, and treated. […] Delirium is a neuropsychiatric condition classically characterized by the acute onset of waxing and waning fluctuations in attention and level of arousal. […] Delirium is diagnosed based on clinical presentation, focusing on the timing of symptom onset, associated symptoms, and thorough mental status and cognitive exams. […] While delirium itself is diagnosed clinically, arriving at a diagnosis is often the first step, followed by a close exploration of potential triggers.

• #66

  https://journals.lww.com/co-supportiveandpalliativecare/fulltext/2014/09000/delirium_diagnosis,_screening_and_management.18.aspx

  Much higher prevalence rates have been reported in palliative care settings, yet the level of recognition and documentation here too is remarkably poor. […] Collectively, delirium recognition problems require solutions at many levels. […] The ideal screening tool should have a high level of sensitivity, be brief and easy to use with minimal training. […] Recent validation and other delirium screening tool studies are summarized in Table 1. […] Although the CAM has been validated in a palliative care population, its sensitivity is very much dependent on user training. […] Studies are needed to rigorously evaluate the benefits and potential harms of screening in relation to multiple outcomes such as medical intervention requirements, preventive strategies, delirium reversibility, care needs and economic burden.

• #67 Diagnosis and Treatment of Terminal Delirium | Palliative Care Network of Wisconsin

  https://www.mypcnow.org/fast-fact/diagnosis-and-treatment-of-terminal-delirium/

  Diagnosis and Treatment of Terminal Delirium […] This Fast Fact reviews assessment and management issues in terminal delirium. […] Delirium can be characterized by a hyperactive/agitated state, a hypoactive state, or a mixture of the two. The hallmark of delirium is an acute change in mentation and attention with either disorganized thinking, easy distractibility, or a fluctuating level of consciousness. […] „Terminal delirium” is not a distinct diagnosis, although it is a commonly used phrase. It implies delirium in a patient in the final days/weeks of life, where treatment of the underlying cause is impossible, impractical, or not consistent with the goals of care. […] Patients need a focused assessment, including orientation to person, place, time, medical situation, and treatment options to better characterize confusion.

• #68

  https://journals.lww.com/co-supportiveandpalliativecare/fulltext/2014/09000/delirium_diagnosis,_screening_and_management.18.aspx

  Much higher prevalence rates have been reported in palliative care settings, yet the level of recognition and documentation here too is remarkably poor. […] Collectively, delirium recognition problems require solutions at many levels. […] The ideal screening tool should have a high level of sensitivity, be brief and easy to use with minimal training. […] Recent validation and other delirium screening tool studies are summarized in Table 1. […] Although the CAM has been validated in a palliative care population, its sensitivity is very much dependent on user training. […] Studies are needed to rigorously evaluate the benefits and potential harms of screening in relation to multiple outcomes such as medical intervention requirements, preventive strategies, delirium reversibility, care needs and economic burden.

• #69 Delirium in terminal cancer inpatients: short-term survival and missed diagnosis

  http://www.scielo.org.mx/scielo.php?script=sci_arttext&pid=S0185-33252018000100025

  Delirium is a neurocognitive disorder, frequently present in advanced cancer patients. It morbidity, mortality, health expenditure, and causes distress to patients, family members, and health care professionals. Despite its impact, the disorder is still underdiagnosed, and consequently, mistreated. […] To describe the prevalence, clinical features, impact on the survival and percentage of missed diagnosis of delirium, in palliative care inpatients treated in a tertiary center. […] We found a 73% of missed delirium diagnosis by the primary referring team. […] Delirium is the principal determinant of short-term mortality, and it is frequently underdiagnosed. […] The presence of delirium diminishes survival in palliative care patients, even as early as 21 days after its onset. […] Regardless of the high prevalence reported, delirium is still underdiagnosed and/or mistreated in patients suffering from cancer. […] We found a 73% of undetected delirium diagnosis in the primary referring team, which is somewhat higher than the 61% rate found in other centers.

• #70 Pediatric Care

  https://www.icudelirium.org/medical-professionals/pediatric-care

  Pediatric delirium is similar to other types of organ dysfunction that our patients suffer from during critical illness. Delirium (acute brain dysfunction) diagnosis requires your assessment of the cardinal features including: acute change or fluctuation of mental status, inattention, acute alteration of the level of consciousness, and/or disorganized thinking/systems. […] The ps/pCAM-ICU were adapted from the adult Confusion Method for the ICU (CAM-ICU). The CAM-ICU series of delirium monitoring tools all demonstrate a hierarchal approach to delirium diagnosis placing weight on the cardinal features of acute/fluctuating mental status and inattention. These core features are the same as outlined in the Diagnostic Statistical Manual of Mental Disorders (DSM) criterion for delirium. […] Delirium should be monitored using the ps/pCAM-ICU at least once per shift AND more often if there is change in behavior or mental status.

• #71 Pediatric Care

  https://www.icudelirium.org/medical-professionals/pediatric-care

  Pediatric delirium is similar to other types of organ dysfunction that our patients suffer from during critical illness. Delirium (acute brain dysfunction) diagnosis requires your assessment of the cardinal features including: acute change or fluctuation of mental status, inattention, acute alteration of the level of consciousness, and/or disorganized thinking/systems. […] The ps/pCAM-ICU were adapted from the adult Confusion Method for the ICU (CAM-ICU). The CAM-ICU series of delirium monitoring tools all demonstrate a hierarchal approach to delirium diagnosis placing weight on the cardinal features of acute/fluctuating mental status and inattention. These core features are the same as outlined in the Diagnostic Statistical Manual of Mental Disorders (DSM) criterion for delirium. […] Delirium should be monitored using the ps/pCAM-ICU at least once per shift AND more often if there is change in behavior or mental status.

• #72 Assessment and Management of Delirium in Pediatric Patients

  https://www.psychiatrist.com/pcc/assessment-and-management-of-delirium-in-pediatric-patients/

  Delirium can be detected and subsequently monitored by using validated assessment tools and scales. […] Delirium develops acutely and can be described as a fluctuation in cognition due to an underlying medical condition (such as the etiologies listed previously). […] Delirium develops in about 25% of children who are admitted to a PICU, with a 38% incidence seen in children who have been admitted for 6 days or more. […] Delirium in children and adolescents has been linked with a higher mortality rate (odds ratio=4.4). […] Delirium is a common and frequently overlooked complication in children who are admitted to the hospital. […] Management of delirium should focus on addressing underlying medical problems and managing pain.

• #73 Delirium: a guide for the general physician

  https://pmc.ncbi.nlm.nih.gov/articles/PMC6329570/

  Delirium describes a sudden onset change in mental status of fluctuating course. This is a state of altered consciousness characterised chiefly by inattention or lack of arousal, but can also include new impairment of language, perception and behaviour. […] Delirium is varied in its presentation, and can be categorised by the psychomotor profile as: hyperactive type (overly vigilant, agitated, often wandersome), hypoactive type (sedate or withdrawn) or mixed types. […] Despite its high prevalence, delirium often goes undetected and undetected delirium is associated with the highest mortality. […] Delirium heralds high risk of falls, longer inpatient stay, post-discharge institutionalisation, accelerated and lasting cognitive decline, and higher mortality. […] Delirium is both common and dangerous, but current evidence suggests it is also preventable in about one third of cases, hence the growing emphasis on the adoption of multicomponent delirium prevention interventions.

• #74 Delirium: What It Is, Symptoms, Treatment & Types

  https://my.clevelandclinic.org/health/diseases/15252-delirium

  Delirium is a type of confusion that happens when the combined strain of illnesses, environmental circumstances or other risk factors disrupts your brain function. Its more common in adults over 65. This condition is serious and can cause long-term or permanent problems, especially with delays in treatment. However, its also often preventable. […] Delirium is a fast-developing type of confusion that affects your ability to focus your attention and awareness. It happens when theres widespread disruption in brain activity, usually because of a combination of factors. Delirium is more common in medical settings, such as during long hospital stays or in long-term care facilities. […] Research indicates that delirium affects between 18% and 35% of people admitted to a hospital for inpatient care. Up to 60% of people in an intensive care unit may experience delirium. However, researchers suspect delirium is more common than statistics indicate. The available research suggests that between 1 in 3 and 2 in 3 delirium cases go undiagnosed.

• #75 Delirium vs. dementia: EMS diagnosis

  https://www.ems1.com/medical-clinical/articles/delirium-vs-dementia-3qd6wYvqcfPxiusu/

  One prospective study found that ED physicians missed approximately 76% of delirium cases, and these cases were nearly all missed by the hospital physician at the time of admission. […] Delirium in ED patients has been associated with increased morbidity and mortality as well as an independent predictor of long-term cognitive decline and dementia. […] History from caregivers and family is often the most vital piece of information to make the diagnosis of delirium, placing frontline EMS personnel in the most advantageous position to screen for the diagnosis. […] The combination of exposure to a patients home environment, primary interaction with caregivers and family, and constant observation of a patient during on-scene stabilization and transport places frontline EMS personnel in the most advantageous position in healthcare to make the diagnosis of delirium.

• #76 Predicting missed delirium diagnosis in a tertiary care center: the Consultation-Liaison at the American University of Beirut (CLAUB) analysis | Middle East Current Psychiatry | Full Text

  https://mecp.springeropen.com/articles/10.1186/s43045-023-00339-9

  Delirium is a very common occurrence in hospital settings and is frequently missed by the primary care team. […] In this study, we aimed to estimate the prevalence of missed delirium diagnosis in a tertiary care center in Lebanon and investigate potential predictors of this missed diagnosis. […] 86.13% of the patients received a delirium diagnosis by the CLP team that had been missed prior to the CLP referral. […] A missed delirium diagnosis was more likely to be found in patients with a history of depression (OR = 24, p0.01) and a longer hospital stay [in days] (OR = 1.04,p = 0.04). […] The alarmingly high prevalence of missed delirium diagnosis is the first evidence of its kind in the Middle East. […] The urgency of this research is heightened by the detrimental sequelae of a delayed or missed detection of delirium.

• #77 Pediatric Care

  https://www.icudelirium.org/medical-professionals/pediatric-care

  Both the ps/pCAM-ICU algorithms mirror that of the adult CAM-ICU assessing the FOUR main features of delirium outlined in the Diagnostic and Statistical Manual of Mental Disorders (DSM). […] The assessment for inattention (Feature 2) can be completed using the TEN developmentally appropriate picture cards included in the Delirium Card Set. […] The most common way to assess for inattention (Feature 2) in older children is to use the Vigilance A test, included on the pCAM-ICU pocket card. […] It is becoming clear that delirium adversely effects both adults and children during critical illness. Additionally, WITHOUT the use of a delirium tool, clinicians miss the diagnosis of delirium in 3 out of 4 patients. […] Understanding Delirium in My Patient is a useful quick reference explaining the overall nature of delirium as it pertains to the ICU patient. Possible approaches to delirium management are included in the Pediatric Delirium Review publication and the delirium algorithms are provided below.

• #78 When Delirium Is Recognized and Addressed Early, Patient Outcomes Improve | Oncology Nursing Society

  https://www.ons.org/publications-research/voice/news-views/05-2023/when-delirium-recognized-and-addressed-early-patient

  An acute state of confusion resulting from organic brain dysfunction, delirium is a medical emergency that can be highly distressing to both patients and caregivers. Approximately 2.6 million older adults experience delirium each year. […] Early identification and management lead to the best outcomes, but delirium is often underdiagnosed because of challenges such as lack of clinician training, environmental distractions (e.g., little privacy, heavy patient load), use of vague or alternative terms (e.g., confusion), and lack of perceived importance. […] Missed diagnoses can extend a hospital stay by 10 days on average, and episodes of delirium can increase the risk of complications, falls, patient and staff distress, restraint use, postacute placement, and costs. […] Poor outcomes, such as an increased risk of morbidity and mortality, are strongly linked to delirium duration and severity, older age, and frailty.

• #79 Delirium – PsychDB

  https://www.psychdb.com/cl/1-delirium

  Doctors and nurses do a poor job of identifying delirium. […] The Confusion Assessment Method (CAM) is a standardized evidence-based tool that allows clinicians to identify and recognize delirium quickly and accurately in both clinical and research settings. […] Obtaining a good history is key and should be the first step when seeing a patient with delirium. […] Delirium should be thought of as a symptom, not a diagnosis. […] One of the prevailing theories of the pathogenesis of delirium is acetylcholine deficiency. […] Acetylcholine plays an extensive role in attention and consciousness, and deficiencies are thought to result in the core symptoms of both hypoactive and hyperactive delirium. […] In non-ICU setting patients, always start with non-pharmacological interventions first, both in the prevention and management of delirium.

• #80 Delirium: a guide for the general physician

  https://pmc.ncbi.nlm.nih.gov/articles/PMC6329570/

  Given its ubiquity and its heterogeneous presentation, delirium diagnosis and management is the responsibility of all clinicians. […] Delirium is characterised by new changes to baseline mental state. […] Delirium is a state of altered consciousness, manifested primarily as impaired arousal (altered level of consciousness) and inattention (altered content of consciousness). […] It is a clinical diagnosis and requires fulfilment of five criteria according to the Diagnostic and Statistical Manual of Mental Disorders, 5th edition. […] Screening tests attempt to identify key features of delirium without which it is unlikely to be present. […] The fluctuating nature of delirium means that serial assessment is required. […] A thorough history is required to elicit possible delirium precipitants, which themselves can be numerous and varied in one individual.

• #81 Delirium Clinical Presentation: History, Physical, Causes

  https://emedicine.medscape.com/article/288890-clinical

  To make an accurate diagnosis, periodic application of diagnostic criteria such as CAM or DSM-5-TR criteria and knowledge of the patient’s baseline mental status is imperative. […] Gaps in the medical record such as once daily cognitive assessment or no formal assessments on the hallmarks of delirium (attention span and fluctuation) may make diagnosing the condition more difficult. […] A simple cognitive test like the Mini-Cog can be a predictor of inhospital delirium. […] The Confusion Assessment Method for the Intensive Care Unit (CAM-ICU) offers the clinician the opportunity to identify delirium in critical care patients, especially patients on mechanical ventilation. […] Another instrument that can be used in ICU settings is the Intensive Care Delirium Screening Checklist (ICDSC).

• #82 Delirium: a guide for the general physician

  https://pmc.ncbi.nlm.nih.gov/articles/PMC6329570/

  Given its ubiquity and its heterogeneous presentation, delirium diagnosis and management is the responsibility of all clinicians. […] Delirium is characterised by new changes to baseline mental state. […] Delirium is a state of altered consciousness, manifested primarily as impaired arousal (altered level of consciousness) and inattention (altered content of consciousness). […] It is a clinical diagnosis and requires fulfilment of five criteria according to the Diagnostic and Statistical Manual of Mental Disorders, 5th edition. […] Screening tests attempt to identify key features of delirium without which it is unlikely to be present. […] The fluctuating nature of delirium means that serial assessment is required. […] A thorough history is required to elicit possible delirium precipitants, which themselves can be numerous and varied in one individual.

• #83 Pediatric Care

  https://www.icudelirium.org/medical-professionals/pediatric-care

  Pediatric delirium is similar to other types of organ dysfunction that our patients suffer from during critical illness. Delirium (acute brain dysfunction) diagnosis requires your assessment of the cardinal features including: acute change or fluctuation of mental status, inattention, acute alteration of the level of consciousness, and/or disorganized thinking/systems. […] The ps/pCAM-ICU were adapted from the adult Confusion Method for the ICU (CAM-ICU). The CAM-ICU series of delirium monitoring tools all demonstrate a hierarchal approach to delirium diagnosis placing weight on the cardinal features of acute/fluctuating mental status and inattention. These core features are the same as outlined in the Diagnostic Statistical Manual of Mental Disorders (DSM) criterion for delirium. […] Delirium should be monitored using the ps/pCAM-ICU at least once per shift AND more often if there is change in behavior or mental status.

• #84

  https://journals.lww.com/co-supportiveandpalliativecare/fulltext/2014/09000/delirium_diagnosis,_screening_and_management.18.aspx

  The diagnosis of delirium is based on clinical assessment and is guided by standard criteria. […] The delirium diagnostic criteria of the International Classification of Diseases, tenth edition (ICD-10) and the recently published Diagnostic Statistical Manual of Mental Disorders, fifth edition (DSM-5) represent definitive standards in terms of diagnosis. […] In research studies, use of either ICD-10 or DSM-5 criteria is recommended as the gold standard diagnostic criteria. […] Subsyndromal delirium (SSD) is a more controversial clinical entity than full syndrome delirium. […] Although SSD does not have universally agreed and clearly defined descriptive diagnostic criteria, it is listed in the neurocognitive disorder section of DSM-5 as attenuated delirium syndrome. […] Recent studies have detected delirium with a prevalence in the range of 20-27% in acute care, and a systematic review reported a documented range of 7-20% in emergency care.

• #85 Delirium diagnosis without a gold standard: Evaluating diagnostic accuracy of combined delirium assessment tools | PLOS One

  https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0267110

  This often leads researchers and patient care teams to combine results from several delirium assessments to increase accuracy of diagnosis. […] The objective of this study was to use latent class models and pairwise Bayesian analyses to evaluate diagnostic accuracy of two combined clinical or two combined family delirium assessment tools used within the same critically ill adult patient. […] The first technique, latent class analysis, assessed performance characteristics (i.e., sensitivity, specificity) without being informed by each tools prior estimated results. […] In contrast, Bayesian analysis specifically accounted for each tools prior performance characteristics in estimating post-test probabilities or performance. […] A gold standard tool [test with 100% diagnostic accuracy] is not available for delirium detection and the development of such a test is likely not feasible or practical.

• #86 New AMA policy opposes “excited delirium” diagnosis | American Medical Association

  https://www.ama-assn.org/press-center/ama-press-releases/new-ama-policy-opposes-excited-delirium-diagnosis

  A policy adopted by physicians, residents, and medical students at the American Medical Associations (AMA) Special Meeting of its House of Delegates (HOD) opposes excited delirium as a medical diagnosis and warns against the use of certain pharmacological interventions solely for a law enforcement purpose without a legitimate medical reason. […] Confirms the AMAs stance that current evidence does not support excited delirium as an official diagnosis, and opposes its use until a clear set of diagnostic criteria has been established […] Denounces excited delirium as a sole justification for law enforcement use of excessive force […] Studies show that the term excited delirium has been misapplied and diagnosed disproportionately in law enforcement-related deaths of Black and Brown individuals, who are also more likely to experience excessive sedative intervention instead of behavioral de-escalation.

• #87 New AMA policy opposes “excited delirium” diagnosis | American Medical Association

  https://www.ama-assn.org/press-center/ama-press-releases/new-ama-policy-opposes-excited-delirium-diagnosis

  A policy adopted by physicians, residents, and medical students at the American Medical Associations (AMA) Special Meeting of its House of Delegates (HOD) opposes excited delirium as a medical diagnosis and warns against the use of certain pharmacological interventions solely for a law enforcement purpose without a legitimate medical reason. […] Confirms the AMAs stance that current evidence does not support excited delirium as an official diagnosis, and opposes its use until a clear set of diagnostic criteria has been established […] Denounces excited delirium as a sole justification for law enforcement use of excessive force […] Studies show that the term excited delirium has been misapplied and diagnosed disproportionately in law enforcement-related deaths of Black and Brown individuals, who are also more likely to experience excessive sedative intervention instead of behavioral de-escalation.

• #88

  https://www.cbsnews.com/news/excited-delirium-doctors-abandon-diagnosis-police-custody-deaths/

  The term „excited delirium” dates back decades but has never been supported by rigorous scientific studies. Still, the term persisted as some of its early researchers earned money for testifying as expert witnesses in cases involving law enforcement and the company now called Axon Enterprises, which makes the Taser stun gun. […] The theory suggested that agitated, delirious individuals were dying not because they had been shocked by stun guns, restrained with chokeholds, or held facedown so they couldn’t breathe, but because of this unexplained medical condition that could lead to sudden death. […] Indeed, excited delirium has been cited more often in cases involving people of color. According to a Virginia Law Review article, at least 56% of police custody deaths from 2010 to 2020 attributed to excited delirium involved Black and Latino victims.

• #89

  https://www.cbsnews.com/news/excited-delirium-doctors-abandon-diagnosis-police-custody-deaths/

  Examining „Excited Delirium” How a questionable syndrome, „Excited Delirium,” could be protecting police officers from misconduct charges […] Excited delirium is not listed in the standard reference book of mental health conditions, nor does it have its own diagnostic code under a system used by health professionals to identify diseases and disorders. No blood test or other diagnostic test can confirm the syndrome. Most major medical societies, including the American Medical Association and the American Psychiatric Association, no longer recognize excited delirium as a legitimate medical condition. […] On Oct. 12, the group approved a resolution that Walsh co-authored to withdraw the 2009 white paper on excited delirium, removing the only remaining official medical pillar of support for a theory, which despite being based primarily on discredited research and racial biases, has played a key role in absolving police of culpability for in-custody deaths.

• #90 Diagnosis of delirium: a practical approach | Practical Neurology

  https://pn.bmj.com/content/23/3/192

  Delirium is an acute disorder of fluctuating attention and awareness with cardinal features that allow it to be positively distinguished from other causes of an acute confusional state. […] We describe a framework for diagnosing delirium, noting the need to consider certain caveats and differential diagnoses. […] Delirium is a clinical diagnosis where a thorough history and clinical examination are much more helpful diagnostically than any single test or combination of tests. […] Delirium is not a diagnosis of exclusion: it has its own cardinal features of fluctuations, prominent inattentiveness with other cognitive deficits, changes in awareness and visual hallucinations, and temporal association with a provoking trigger (and improvement with treatment or removal of that trigger). […] We emphasise that delirium is a clinical diagnosis where thoroughness of history-taking and clinical examination are diagnostically much more helpful than any single or combination of paraclinical test(s).

• #91 Delirium: a guide for the general physician

  https://pmc.ncbi.nlm.nih.gov/articles/PMC6329570/

  Given its ubiquity and its heterogeneous presentation, delirium diagnosis and management is the responsibility of all clinicians. […] Delirium is characterised by new changes to baseline mental state. […] Delirium is a state of altered consciousness, manifested primarily as impaired arousal (altered level of consciousness) and inattention (altered content of consciousness). […] It is a clinical diagnosis and requires fulfilment of five criteria according to the Diagnostic and Statistical Manual of Mental Disorders, 5th edition. […] Screening tests attempt to identify key features of delirium without which it is unlikely to be present. […] The fluctuating nature of delirium means that serial assessment is required. […] A thorough history is required to elicit possible delirium precipitants, which themselves can be numerous and varied in one individual.

• #92 Diagnosis, prevention and management of delirium: spot it, stop it, treat it | BJPsych Advances | Cambridge Core

  https://www.cambridge.org/core/journals/bjpsych-advances/article/diagnosis-prevention-and-management-of-delirium-spot-it-stop-it-treat-it/3F58BA5AE303B426E9FE72817D847F29

  Delirium frequently occurs among hospital in-patients, with significant attributable healthcare costs. […] The purpose of this article is to inform clinicians of the best practices for spotting, stopping and treating delirium and provide guidance on common challenging clinical dilemmas. […] For spotting delirium, suggested screening tools are the 4 A’s Test (in general medical settings) and the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU). […] Delirium is commonly experienced by older adult hospital in-patients, with an estimated overall prevalence of 23% in general medical settings and even higher, at 31.8%, among patients in the intensive care unit (ICU). […] The first step in the evaluation of delirium is the history obtained from an informed observer (e.g. family member or staff), followed by a cognitive assessment to screen and confirm delirium.

• #93 When Delirium Is Recognized and Addressed Early, Patient Outcomes Improve | Oncology Nursing Society

  https://www.ons.org/publications-research/voice/news-views/05-2023/when-delirium-recognized-and-addressed-early-patient

  An acute state of confusion resulting from organic brain dysfunction, delirium is a medical emergency that can be highly distressing to both patients and caregivers. Approximately 2.6 million older adults experience delirium each year. […] Early identification and management lead to the best outcomes, but delirium is often underdiagnosed because of challenges such as lack of clinician training, environmental distractions (e.g., little privacy, heavy patient load), use of vague or alternative terms (e.g., confusion), and lack of perceived importance. […] Missed diagnoses can extend a hospital stay by 10 days on average, and episodes of delirium can increase the risk of complications, falls, patient and staff distress, restraint use, postacute placement, and costs. […] Poor outcomes, such as an increased risk of morbidity and mortality, are strongly linked to delirium duration and severity, older age, and frailty.

• #94 Delirium: a guide for the general physician

  https://pmc.ncbi.nlm.nih.gov/articles/PMC6329570/

  Delirium describes a sudden onset change in mental status of fluctuating course. This is a state of altered consciousness characterised chiefly by inattention or lack of arousal, but can also include new impairment of language, perception and behaviour. […] Delirium is varied in its presentation, and can be categorised by the psychomotor profile as: hyperactive type (overly vigilant, agitated, often wandersome), hypoactive type (sedate or withdrawn) or mixed types. […] Despite its high prevalence, delirium often goes undetected and undetected delirium is associated with the highest mortality. […] Delirium heralds high risk of falls, longer inpatient stay, post-discharge institutionalisation, accelerated and lasting cognitive decline, and higher mortality. […] Delirium is both common and dangerous, but current evidence suggests it is also preventable in about one third of cases, hence the growing emphasis on the adoption of multicomponent delirium prevention interventions.

• #95 Diagnosis of delirium: a practical approach | Practical Neurology

  https://pn.bmj.com/content/23/3/192

  Delirium is an acute disorder of fluctuating attention and awareness with cardinal features that allow it to be positively distinguished from other causes of an acute confusional state. […] We describe a framework for diagnosing delirium, noting the need to consider certain caveats and differential diagnoses. […] Delirium is a clinical diagnosis where a thorough history and clinical examination are much more helpful diagnostically than any single test or combination of tests. […] Delirium is not a diagnosis of exclusion: it has its own cardinal features of fluctuations, prominent inattentiveness with other cognitive deficits, changes in awareness and visual hallucinations, and temporal association with a provoking trigger (and improvement with treatment or removal of that trigger). […] We emphasise that delirium is a clinical diagnosis where thoroughness of history-taking and clinical examination are diagnostically much more helpful than any single or combination of paraclinical test(s).

• #96 Diagnosis of delirium: a practical approach | Practical Neurology

  https://pn.bmj.com/content/23/3/192

  Delirium is an acute disorder of fluctuating attention and awareness with cardinal features that allow it to be positively distinguished from other causes of an acute confusional state. […] We describe a framework for diagnosing delirium, noting the need to consider certain caveats and differential diagnoses. […] Delirium is a clinical diagnosis where a thorough history and clinical examination are much more helpful diagnostically than any single test or combination of tests. […] Delirium is not a diagnosis of exclusion: it has its own cardinal features of fluctuations, prominent inattentiveness with other cognitive deficits, changes in awareness and visual hallucinations, and temporal association with a provoking trigger (and improvement with treatment or removal of that trigger). […] We emphasise that delirium is a clinical diagnosis where thoroughness of history-taking and clinical examination are diagnostically much more helpful than any single or combination of paraclinical test(s).

• #97 Delirium in older adults: Diagnosis, prevention, and treatment | British Columbia Medical Journal

  https://bcmj.org/articles/delirium-older-adults-diagnosis-prevention-and-treatment

  Delirium is common in hospitalized older adults and is known to increase the risk for subsequent functional decline and mortality. […] A high index of suspicion can allow clinicians to recognize delirium promptly and search for the underlying cause. […] Workup includes a thorough history, physical examination, and investigations to identify acute illness or destabilized chronic conditions. […] Therapy focuses on treating the triggering cause as well as addressing patient-specific and environmental risk factors that may contribute to the development or worsening of delirium. […] While antipsychotics can be used off-label to manage symptoms of delirium, they do not treat the underlying cause and are associated with side effects. […] Recognizing delirium promptly and treating the underlying cause can prevent the significant consequences of an acute disturbance in cognition, which include cognitive and functional decline, falls, and admission to long-term care.

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