{"id":1087,"date":"2020-08-20T03:25:40","date_gmt":"2020-08-20T03:25:40","guid":{"rendered":"https:\/\/courses.lumenlearning.com\/abnormalpsych\/?post_type=chapter&#038;p=1087"},"modified":"2022-07-26T20:06:45","modified_gmt":"2022-07-26T20:06:45","slug":"delirium","status":"publish","type":"chapter","link":"https:\/\/courses.lumenlearning.com\/wm-abnormalpsych\/chapter\/delirium\/","title":{"raw":"Delirium","rendered":"Delirium"},"content":{"raw":"<div class=\"textbox learning-objectives\">\r\n<h3>Learning Objectives<\/h3>\r\n<ul>\r\n \t<li>Explain delirium and its etiology<\/li>\r\n<\/ul>\r\n<\/div>\r\n<b>Delirium<\/b>, also known as\u00a0<b>acute confusional state<\/b>, is an organically caused decline from a previous baseline mental functioning that develops over a short period of time, typically hours to days.\u00a0Delirium is a\u00a0syndrome\u00a0encompassing disturbances in attention, consciousness, and cognition. Delirium may also involve other neurological deficits, such as psychomotor disturbances (e.g., hyperactive, hypoactive, or mixed), impaired sleep-wake cycle, emotional disturbances, and perceptual disturbances (e.g., hallucinations and delusions), although these features are not required for diagnosis.\r\n\r\n[caption id=\"attachment_2057\" align=\"alignright\" width=\"208\"]<img class=\"wp-image-2057 size-medium\" src=\"https:\/\/s3-us-west-2.amazonaws.com\/courses-images\/wp-content\/uploads\/sites\/5351\/2020\/08\/17123242\/Mental_diseases._A_text-book_of_psychiatry_for_medical_students_and_practitioners_1913_14592098880-208x300.jpg\" alt=\"Old sketch from a 1910 textbook of a man with delirium who is attached to a bed in what looks like a jail cell.\" width=\"208\" height=\"300\" \/> <strong>Figure 1<\/strong>. Delirium is an acute disturbance of mental abilities.[\/caption]\r\n\r\nDelirium is caused by an acute\u00a0organic process, which is a physically identifiable structural, functional, or chemical problem in the brain that may arise from a disease process\u00a0<i>outside<\/i>\u00a0the brain that nonetheless affects the brain. Delirium may result from an underlying disease process (e.g., infection or hypoxia), a side effect of a medication, withdrawal from drugs, over-consumption of\u00a0alcohol, usage of\u00a0hallucinogenic deliriants, or from any number of factors affecting one's overall health (e.g., malnutrition, pain, etc.). In contrast, fluctuations in mental status\/function due to changes in primarily psychiatric processes or diseases (e.g., schizophrenia or bipolar disorder) do not, by definition, meet the criteria for delirium.\r\n\r\nDelirium may be difficult to diagnose without the proper establishment of a person's usual mental function. Without careful assessment and history, delirium can easily be confused with a number of\u00a0psychiatric disorders\u00a0or chronic\u00a0organic brain syndromes\u00a0because of many overlapping signs and\u00a0symptoms\u00a0in common with\u00a0dementia,\u00a0depression,\u00a0psychosis, etc.\u00a0Delirium may manifest from a baseline of existing mental illness, baseline intellectual development disorder (intellectual disability), or dementia, without being due to any of these problems.\u00a0Delirium is distinguished from\u00a0dementia\u00a0(chronic organic brain syndrome), which describes an acquired (non-congenital) and usually irreversible cognitive and psychosocial decline in function.\r\n<div class=\"textbox key-takeaways\">\r\n<h3>The difference between delirium and similar psychiatric illness<\/h3>\r\nDelirium is a disorder that makes situational awareness and processing new information very difficult for those diagnosed. Delirium usually has a high rate of onset ranging from minutes to hours and sometimes days, but it does not last for very long, only a few hours to weeks. Delirium can also be accompanied by a shift in attention, mood swings, violent or unordinary behaviors, and hallucinations. Delirium may be caused by a preexisting medical condition. Delirium is noted by sudden changes in cognition. Alzheimer's disease, depression, and some psychotic disorders tend to be more of a gradual cognition decline.\r\n<table style=\"height: 248px;\" border=\"3\"><caption>\u00a0<\/caption>\r\n<tbody>\r\n<tr style=\"height: 11px;\">\r\n<th style=\"height: 11px; width: 917.65px;\" colspan=\"5\">Table 1. Characteristics of delirium, Alzheimer's disease, depression, and psychotic disorders<\/th>\r\n<\/tr>\r\n<tr style=\"height: 23px;\">\r\n<th style=\"height: 23px; width: 85.65px;\">Attributes<\/th>\r\n<th style=\"height: 23px; width: 220.85px;\">Delirium<\/th>\r\n<th style=\"height: 23px; width: 304.85px;\">Alzheimer's disease<\/th>\r\n<th style=\"height: 23px; width: 162.45px;\">Depression<\/th>\r\n<th style=\"height: 23px; width: 99.25px;\">Psychotic Disorders<\/th>\r\n<\/tr>\r\n<tr style=\"height: 11px;\">\r\n<th style=\"height: 11px; width: 85.65px;\">Onset<\/th>\r\n<td style=\"height: 11px; width: 220.85px;\">Sudden\/acute\/subacute<\/td>\r\n<td style=\"height: 11px; width: 304.85px;\">Gradual<\/td>\r\n<td style=\"height: 11px; width: 162.45px;\">Gradual<\/td>\r\n<td style=\"height: 11px; width: 99.25px;\">Acute or gradual<\/td>\r\n<\/tr>\r\n<tr style=\"height: 23px;\">\r\n<th style=\"height: 23px; width: 85.65px;\">Progression<\/th>\r\n<td style=\"height: 23px; width: 220.85px;\">Shifts in severity, likely to resolve in days to weeks.<\/td>\r\n<td style=\"height: 23px; width: 304.85px;\">Worsens over a period of time<\/td>\r\n<td style=\"height: 23px; width: 162.45px;\">Acute or chronic with acute exacerbation<\/td>\r\n<td style=\"height: 23px; width: 99.25px;\">Chronic with acute exacerbation<\/td>\r\n<\/tr>\r\n<tr style=\"height: 23px;\">\r\n<th style=\"height: 23px; width: 85.65px;\">Hallucinations<\/th>\r\n<td style=\"height: 23px; width: 220.85px;\">May be present, mostly visual<\/td>\r\n<td style=\"height: 23px; width: 304.85px;\">Mostly absent (exceptions: Lewi body dementia, etc.)<\/td>\r\n<td style=\"height: 23px; width: 162.45px;\">May be present if associated with psychotic features<\/td>\r\n<td style=\"height: 23px; width: 99.25px;\">Present<\/td>\r\n<\/tr>\r\n<tr style=\"height: 11px;\">\r\n<th style=\"height: 11px; width: 85.65px;\">Delusions<\/th>\r\n<td style=\"height: 11px; width: 220.85px;\">Fleeting<\/td>\r\n<td style=\"height: 11px; width: 304.85px;\">Mostly not present<\/td>\r\n<td style=\"height: 11px; width: 162.45px;\">May be present<\/td>\r\n<td style=\"height: 11px; width: 99.25px;\">Present<\/td>\r\n<\/tr>\r\n<tr style=\"height: 23px;\">\r\n<th style=\"height: 23px; width: 85.65px;\">Psychomotor activity<\/th>\r\n<td style=\"height: 23px; width: 220.85px;\">Increased or decreased, may shift from increased to decreased states.<\/td>\r\n<td style=\"height: 23px; width: 304.85px;\">May or may not change<\/td>\r\n<td style=\"height: 23px; width: 162.45px;\">Change<\/td>\r\n<td style=\"height: 23px; width: 99.25px;\">Change<\/td>\r\n<\/tr>\r\n<tr style=\"height: 23px;\">\r\n<th style=\"height: 23px; width: 85.65px;\">Attention<\/th>\r\n<td style=\"height: 23px; width: 220.85px;\">Poor attention span and impaired short term memory.<\/td>\r\n<td style=\"height: 23px; width: 304.85px;\">Progressive worsening short-term memory. Attention span is likely to be affected in severe cases<\/td>\r\n<td style=\"height: 23px; width: 162.45px;\">May be altered<\/td>\r\n<td style=\"height: 23px; width: 99.25px;\">May be altered<\/td>\r\n<\/tr>\r\n<tr style=\"height: 11px;\">\r\n<th style=\"height: 11px; width: 85.65px;\">Consciousness<\/th>\r\n<td style=\"height: 11px; width: 220.85px;\">Altered, rapidly shifts<\/td>\r\n<td style=\"height: 11px; width: 304.85px;\">Mostly intact until severe stages<\/td>\r\n<td style=\"height: 11px; width: 162.45px;\">Normal<\/td>\r\n<td style=\"height: 11px; width: 99.25px;\">Normal<\/td>\r\n<\/tr>\r\n<tr style=\"height: 11px;\">\r\n<th style=\"height: 11px; width: 85.65px;\">Attention<\/th>\r\n<td style=\"height: 11px; width: 220.85px;\">Altered, rapidly shifts<\/td>\r\n<td style=\"height: 11px; width: 304.85px;\">Mostly intact until severe stages<\/td>\r\n<td style=\"height: 11px; width: 162.45px;\">May be altered<\/td>\r\n<td style=\"height: 11px; width: 99.25px;\">May be altered<\/td>\r\n<\/tr>\r\n<tr style=\"height: 11px;\">\r\n<th style=\"height: 11px; width: 85.65px;\">Orientation<\/th>\r\n<td style=\"height: 11px; width: 220.85px;\">Altered, rapidly shifts<\/td>\r\n<td style=\"height: 11px; width: 304.85px;\">Mostly intact until severe stages<\/td>\r\n<td style=\"height: 11px; width: 162.45px;\">Not altered<\/td>\r\n<td style=\"height: 11px; width: 99.25px;\">Not altered<\/td>\r\n<\/tr>\r\n<tr style=\"height: 23px;\">\r\n<th style=\"height: 23px; width: 85.65px;\">Speech<\/th>\r\n<td style=\"height: 23px; width: 220.85px;\">Not coherent<\/td>\r\n<td style=\"height: 23px; width: 304.85px;\">Errors<\/td>\r\n<td style=\"height: 23px; width: 162.45px;\">Slow<\/td>\r\n<td style=\"height: 23px; width: 99.25px;\">Normal or pressured<\/td>\r\n<\/tr>\r\n<tr style=\"height: 11px;\">\r\n<th style=\"height: 11px; width: 85.65px;\">Thought<\/th>\r\n<td style=\"height: 11px; width: 220.85px;\">Disorganized<\/td>\r\n<td style=\"height: 11px; width: 304.85px;\">Impoverished<\/td>\r\n<td style=\"height: 11px; width: 162.45px;\">Normal<\/td>\r\n<td style=\"height: 11px; width: 99.25px;\">Disorganized<\/td>\r\n<\/tr>\r\n<tr style=\"height: 11px;\">\r\n<th style=\"height: 11px; width: 85.65px;\">Perceptions<\/th>\r\n<td style=\"height: 11px; width: 220.85px;\">Altered, rapidly shifts<\/td>\r\n<td style=\"height: 11px; width: 304.85px;\">Mostly intact until severe stages<\/td>\r\n<td style=\"height: 11px; width: 162.45px;\">Normal<\/td>\r\n<td style=\"height: 11px; width: 99.25px;\">May be altered<\/td>\r\n<\/tr>\r\n<tr style=\"height: 11px;\">\r\n<th style=\"height: 11px; width: 85.65px;\">EEG<\/th>\r\n<td style=\"height: 11px; width: 220.85px;\">Moderate to severe background slowing<\/td>\r\n<td style=\"height: 11px; width: 304.85px;\">Normal or mild diffuse slowing<\/td>\r\n<td style=\"height: 11px; width: 162.45px;\">Normal<\/td>\r\n<td style=\"height: 11px; width: 99.25px;\">Normal<\/td>\r\n<\/tr>\r\n<tr style=\"height: 11px;\">\r\n<th style=\"height: 11px; width: 85.65px;\">Reversibility<\/th>\r\n<td style=\"height: 11px; width: 220.85px;\">Mostly<\/td>\r\n<td style=\"height: 11px; width: 304.85px;\">Very rarely<\/td>\r\n<td style=\"height: 11px; width: 162.45px;\">Yes<\/td>\r\n<td style=\"height: 11px; width: 99.25px;\">Rarely<\/td>\r\n<\/tr>\r\n<\/tbody>\r\n<\/table>\r\n&nbsp;\r\n\r\n<\/div>\r\nDelirium exists as a stage of consciousness somewhere in the spectrum between normal awake\/alert state and coma. While requiring an acute disturbance in\u00a0consciousness\/attention and\u00a0cognition, delirium is a syndrome encompassing an array of neuropsychiatric symptoms. Delirium arises through the interaction of a number of predisposing and precipitating factors.\r\n\r\nThe most important predisposing factors are\r\n<ul>\r\n \t<li>older age (&gt; 65 years old)<\/li>\r\n \t<li>male sex<\/li>\r\n \t<li>cognitive impairment \/\u00a0dementia<\/li>\r\n \t<li>physical comorbidity (biventricular failure,\u00a0cancer,\u00a0 and cerebrovascular disease)<\/li>\r\n \t<li>psychiatric comorbidity (e.g.,\u00a0depression)<\/li>\r\n \t<li>sensory impairment (vision, hearing)<\/li>\r\n \t<li>functional dependence (e.g., requiring assistance for self-care or mobility)<\/li>\r\n \t<li>dehydration\/malnutrition<\/li>\r\n \t<li>drugs and drug-dependence<\/li>\r\n \t<li>alcohol dependence<\/li>\r\n<\/ul>\r\nIndividuals with multiple and\/or significant predisposing factors are highly at risk for suffering an episode of delirium with a single and\/or mild precipitating factor. Conversely, delirium may only result in healthy individuals if they suffer serious or multiple precipitating factors. The factors affecting an individual may change over time, thus an individual\u2019s risk of delirium is dynamic.\r\n\r\nSome of the most common precipitating factors of delirium\u00a0are listed below:\r\n<ul>\r\n \t<li>prolonged sleep deprivation<\/li>\r\n \t<li>environmental or physical\/psychological stress\r\n<ul>\r\n \t<li>inadequately controlled pain<\/li>\r\n \t<li>admission to an intensive care unit<\/li>\r\n \t<li>immobilization or use of physical restraints<\/li>\r\n \t<li>urinary retention or use of a bladder catheter<\/li>\r\n \t<li>emotional stress<\/li>\r\n \t<li>severe constipation and\/or fecal impaction<\/li>\r\n<\/ul>\r\n<\/li>\r\n \t<li>medications\r\n<ul>\r\n \t<li>sedatives (benzodiazepines,\u00a0opioids),\u00a0anticholinergics,\u00a0dopaminergics, corticosteroids,\u00a0polypharmacy<\/li>\r\n \t<li>general anesthetic<\/li>\r\n \t<li>substance intoxication or withdrawal<\/li>\r\n<\/ul>\r\n<\/li>\r\n \t<li>primary neurologic diseases\r\n<ul>\r\n \t<li>severe drop in blood pressure, relative to the patient\u2019s normal blood pressure (orthostatic hypotension) resulting in inadequate blood flow to the brain (cerebral hypoperfusion)<\/li>\r\n \t<li>stroke\/Transient ischemic attack (TIA)<\/li>\r\n \t<li>intracranial bleeding<\/li>\r\n \t<li>brain inflammation from meningitis or encephalitis<\/li>\r\n<\/ul>\r\n<\/li>\r\n \t<li>Concurrent illness\r\n<ul>\r\n \t<li>Infections \u2013 especially respiratory (e.g.\u00a0pneumonia) and\u00a0urinary tract infections<\/li>\r\n \t<li>Latrogenic\u00a0complications<\/li>\r\n \t<li>Hypoxia,\u00a0hypercapnea,\u00a0anemia<\/li>\r\n \t<li>Poor nutritional status, dehydration, electrolyte imbalances,\u00a0hypoglycemia<\/li>\r\n \t<li>Cardiac shock,\u00a0heart attacks,\u00a0heart failure<\/li>\r\n \t<li>Metabolic derangements (e.g.\u00a0SIADH,\u00a0Addison\u2019s disease,\u00a0hyperthyroidism)<\/li>\r\n \t<li>Chronic or terminal illness (e.g. cancer)<\/li>\r\n \t<li>Post-traumatic event (e.g. fall, fracture)<\/li>\r\n<\/ul>\r\n<\/li>\r\n \t<li>Surgery\r\n<ul>\r\n \t<li>Cardiac, orthopedic, prolonged\u00a0cardiopulmonary bypass, thoracic surgeries<\/li>\r\n<\/ul>\r\n<\/li>\r\n<\/ul>\r\nThe range of <strong><em>clinical features<\/em><\/strong> includes\u00a0poor attention\/vigilance\u00a0(100%), memory impairment (64\u2013100%), clouding of consciousness (45\u2013100%), disorientation (43\u2013100%), acute onset (93%), disorganized thinking\/thought disorder (59\u201395%), diffuse cognitive impairment (77%), language disorder (41\u201393%), sleep disturbance (25\u201396%),\u00a0mood lability\u00a0(43\u201363%), psychomotor changes (e.g. hyperactive, hypoactive, mixed) (38\u201355%), delusions (18\u201368%), and perceptual change\/hallucinations (17\u201355%).\r\n\r\nThese various clinical features of delirium are further described below and can be assessed by several specialized tests, such as The Delirium Rating Scale-Revised-98 (DRS-R-98):\r\n\r\n[caption id=\"attachment_4525\" align=\"alignright\" width=\"218\"]<img class=\"wp-image-4525\" src=\"https:\/\/s3-us-west-2.amazonaws.com\/courses-images\/wp-content\/uploads\/sites\/5351\/2020\/08\/18042205\/How_much_sleep_should_kids_get_120050450-221x300.jpg\" alt=\"A person in bed in an uncomfortable position.\" width=\"218\" height=\"296\" \/> <strong>Figure 2.<\/strong> Sleep disturbances and deprivation are risk factors for delirium.[\/caption]\r\n<ul>\r\n \t<li><em>Inattention<\/em>: As a required symptom to diagnose delirium, inattention is characterized by distractibility and an inability to shift and\/or sustain\u00a0attention.<\/li>\r\n \t<li><em>Memory impairment<\/em><span style=\"font-size: 1rem; text-align: initial;\">:\u00a0Memory impairment\u00a0is linked to inattention, especially reduced formation of new\u00a0<\/span><i style=\"font-size: 1rem; text-align: initial;\">long-term<\/i><span style=\"font-size: 1rem; text-align: initial;\">\u00a0memory where higher degrees of attention is more necessary than for short-term memory. Since older memories are retained without the need for concentration, previously formed long-term memories (i.e., those formed before the onset of delirium) are usually preserved in all but the most severe cases of delirium.<\/span><\/li>\r\n \t<li><em>Disorientation<\/em>:<span style=\"font-size: 1rem; text-align: initial;\">\u00a0As another symptom of confusion, and usually a more severe one, disorientation describes the loss of awareness of the surroundings, environment, and context in which the person exists. An individual may be disoriented to time, place, or self.<\/span><\/li>\r\n \t<li><em>Disorganized thinking<\/em><span style=\"font-size: 1rem; text-align: initial;\">:\u00a0Disorganized thinking\u00a0is usually noticed with speech that makes limited sense with apparent irrelevancies, and can involve\u00a0poverty of speech,\u00a0loose associations,\u00a0perseveration,\u00a0tangentiality, and other signs of a formal thought disorder.<\/span><\/li>\r\n \t<li><em>Language disturbances<\/em><span style=\"font-size: 1rem; text-align: initial;\"><span style=\"font-size: 1rem; text-align: initial;\">:\u00a0Anomic aphasia,\u00a0paraphasia, impaired comprehension,\u00a0agraphia, and word-finding diffi<\/span><\/span>culties all involve impairment of linguistic information processing.<\/li>\r\n \t<li><em>Sleep changes<\/em><span style=\"font-size: 1rem; text-align: initial;\">: Sleep disturbances in delirium reflect disturbed circadian rhythm regulation, typically involving fragmented sleep or even sleep-wake cycle reversal (i.e., active at night and sleeping during the day) and often preceding the onset of a delirium episode<\/span><\/li>\r\n \t<li><em>Psychotic symptoms<\/em>:<span style=\"font-size: 1rem; text-align: initial;\">\u00a0Symptoms of\u00a0psychosis\u00a0include suspiciousness, overvalued ideation, and frank delusions.\u00a0Delusions\u00a0are typically poorly formed and less\u00a0stereotyped\u00a0than in schizophrenia or Alzheimer\u2019s disease. The delusions usually relate to persecutory themes of impending danger or threat in the immediate environment (e.g., being poisoned by nurses).<\/span><\/li>\r\n \t<li><em>Mood lability<\/em><span style=\"font-size: 1rem; text-align: initial;\">: Distortions to perceived or communicated emotional states as well as\u00a0fluctuating emotional states\u00a0can manifest in a delirious person (e.g., rapid changes between terror, sadness, and joking).<\/span><\/li>\r\n \t<li><em>Motor activity changes<\/em>:<span style=\"font-size: 1rem; text-align: initial;\">\u00a0Delirium has been commonly classified into psychomotor subtypes of hypoactive, hyperactive, and mixed,\u00a0though studies are inconsistent as to the prevalence of these subtypes.\u00a0Hypoactive cases are prone to non-detection or misdiagnosis as depression. A range of studies suggest that motor subtypes differ regarding underlying pathophysiology, treatment needs, and prognosis for function and mortality though inconsistent subtype definitions and poorer detection of hypoactive subtypes impact the interpretation of these findings.<\/span><\/li>\r\n<\/ul>\r\nTreatment of delirium requires identifying and managing the underlying causes, managing delirium symptoms, and reducing the risk of complications.\u00a0In some cases, temporary or symptomatic treatments are used to comfort the person or to facilitate other care (e.g., preventing people from pulling out a breathing tube).\u00a0Antipsychotics\u00a0are not supported for the treatment or prevention of delirium among those who are in hospital.\u00a0When delirium is caused by alcohol or\u00a0sedative-hypnotic\u00a0withdrawal,\u00a0benzodiazepines\u00a0are typically used. Evidence has found that the risk of delirium in hospitalized people can be reduced by systematic good general care.\u00a0Delirium affects 14\u201324% of all hospitalized individuals. The overall prevalence for the general population is 1%-2% but this prevalence increases with age, reaching 14% of adults over age 85. Among older adults, delirium occurs in 15\u201353% of those post-surgery, 70\u201387% of those in the\u00a0ICU, up to 60% of those in nursing homes or post-acute care settings.\u00a0Among individuals requiring critical care, delirium is a risk for death within the next year.\r\n<h2><span id=\"Prevention\" class=\"mw-headline\">Prevention<\/span><\/h2>\r\nThere is substantial evidence that delirium results in long-term poor outcomes in older persons admitted to hospital.\u00a0Recent long-term studies showed that many patients still meet the criteria for delirium for a prolonged period after hospital discharge, with up to 21% of patients showing persistent delirium at six months post-discharge.\r\n\r\nUsing a tailored multifaceted approach clinicians can decrease rates of delirium by 27% among the elderly.\u00a0At least 30\u201340% of all cases of delirium could be prevented, and high rates of delirium reflect negatively on the quality of care.\u00a0Episodes of delirium can be prevented by identifying hospitalized people at risk of the condition: those over age 65, those with a known cognitive impairment, those with\u00a0hip fracture, those with severe illness.\r\n\r\nDelirium may be prevented and treated by using non-pharmacologic approaches focused on risk factors, such as constipation, dehydration, low oxygen levels, immobility, visual or hearing impairment, sleep deprivation, functional decline, and removing or minimizing problematic medications.<sup id=\"cite_ref-NICE_59-1\" class=\"reference\"><\/sup>\u00a0Ensuring a therapeutic environment (e.g., individualized care; clear communication; adequate reorientation and lighting during daytime; promoting uninterrupted\u00a0sleep hygiene\u00a0with minimal noise and light at night; minimizing bed relocation; having familiar objects like family pictures; providing earplugs; and providing adequate nutrition, pain control, and assistance toward early mobilization) can also yield benefit toward preventing delirium.<sup id=\"cite_ref-Siddiqi2016_4-1\" class=\"reference\"><\/sup><sup id=\"cite_ref-Inouye2006_20-2\" class=\"reference\"><\/sup><sup id=\"cite_ref-60\" class=\"reference\"><\/sup>\u00a0Research into pharmacologic prevention and treatment is weak and insufficient to make proper recommendations.\r\n<div class=\"textbox examples\">\r\n<h3>watch It<\/h3>\r\nThis video provides an overview of the causes, symptoms, diagnosis, and treatment of delirium.\r\n\r\n[embed]https:\/\/youtu.be\/qmMYsVaZ0zo[\/embed]\r\n\r\nYou can view the <a href=\"https:\/\/course-building.s3-us-west-2.amazonaws.com\/Abnormal+Psychology\/transcripts\/DeliriumCausesSymptomsDiagnosis_transcript.txt\" target=\"_blank\" rel=\"noopener\">transcript for \"Delirium - causes, symptoms, diagnosis, treatment &amp; pathology\" here (opens in new window)<\/a>.\r\n\r\n<\/div>\r\n<div class=\"textbox key-takeaways\">\r\n<h3>Key Takeaways: Delirium<\/h3>\r\n<iframe title=\"69. Delirium\" src=\"https:\/\/lumenlearning.h5p.com\/content\/1291236408646173468\/embed\" width=\"1088\" height=\"859\" frameborder=\"0\" allowfullscreen=\"allowfullscreen\"><\/iframe><script src=\"https:\/\/lumenlearning.h5p.com\/js\/h5p-resizer.js\" charset=\"UTF-8\"><\/script>\r\n\r\n<\/div>\r\n<div class=\"textbox tryit\">\r\n<h3>Try It<\/h3>\r\nhttps:\/\/assess.lumenlearning.com\/practice\/f9e64bf9-8ef8-4b9d-85d0-7daae9a6468d\r\n\r\nhttps:\/\/assess.lumenlearning.com\/practice\/c6dbc950-6451-4655-a654-602122dc3fac\r\n\r\n<\/div>\r\n<div class=\"textbox learning-objectives\">\r\n<h3>Glossary<\/h3>\r\n<b>delirium:<\/b>\u00a0an organically caused decline from a previous baseline mental functioning that develops over a short period of time, typically hours to days\r\n\r\n<\/div>","rendered":"<div class=\"textbox learning-objectives\">\n<h3>Learning Objectives<\/h3>\n<ul>\n<li>Explain delirium and its etiology<\/li>\n<\/ul>\n<\/div>\n<p><b>Delirium<\/b>, also known as\u00a0<b>acute confusional state<\/b>, is an organically caused decline from a previous baseline mental functioning that develops over a short period of time, typically hours to days.\u00a0Delirium is a\u00a0syndrome\u00a0encompassing disturbances in attention, consciousness, and cognition. Delirium may also involve other neurological deficits, such as psychomotor disturbances (e.g., hyperactive, hypoactive, or mixed), impaired sleep-wake cycle, emotional disturbances, and perceptual disturbances (e.g., hallucinations and delusions), although these features are not required for diagnosis.<\/p>\n<div id=\"attachment_2057\" style=\"width: 218px\" class=\"wp-caption alignright\"><img loading=\"lazy\" decoding=\"async\" aria-describedby=\"caption-attachment-2057\" class=\"wp-image-2057 size-medium\" src=\"https:\/\/s3-us-west-2.amazonaws.com\/courses-images\/wp-content\/uploads\/sites\/5351\/2020\/08\/17123242\/Mental_diseases._A_text-book_of_psychiatry_for_medical_students_and_practitioners_1913_14592098880-208x300.jpg\" alt=\"Old sketch from a 1910 textbook of a man with delirium who is attached to a bed in what looks like a jail cell.\" width=\"208\" height=\"300\" \/><\/p>\n<p id=\"caption-attachment-2057\" class=\"wp-caption-text\"><strong>Figure 1<\/strong>. Delirium is an acute disturbance of mental abilities.<\/p>\n<\/div>\n<p>Delirium is caused by an acute\u00a0organic process, which is a physically identifiable structural, functional, or chemical problem in the brain that may arise from a disease process\u00a0<i>outside<\/i>\u00a0the brain that nonetheless affects the brain. Delirium may result from an underlying disease process (e.g., infection or hypoxia), a side effect of a medication, withdrawal from drugs, over-consumption of\u00a0alcohol, usage of\u00a0hallucinogenic deliriants, or from any number of factors affecting one&#8217;s overall health (e.g., malnutrition, pain, etc.). In contrast, fluctuations in mental status\/function due to changes in primarily psychiatric processes or diseases (e.g., schizophrenia or bipolar disorder) do not, by definition, meet the criteria for delirium.<\/p>\n<p>Delirium may be difficult to diagnose without the proper establishment of a person&#8217;s usual mental function. Without careful assessment and history, delirium can easily be confused with a number of\u00a0psychiatric disorders\u00a0or chronic\u00a0organic brain syndromes\u00a0because of many overlapping signs and\u00a0symptoms\u00a0in common with\u00a0dementia,\u00a0depression,\u00a0psychosis, etc.\u00a0Delirium may manifest from a baseline of existing mental illness, baseline intellectual development disorder (intellectual disability), or dementia, without being due to any of these problems.\u00a0Delirium is distinguished from\u00a0dementia\u00a0(chronic organic brain syndrome), which describes an acquired (non-congenital) and usually irreversible cognitive and psychosocial decline in function.<\/p>\n<div class=\"textbox key-takeaways\">\n<h3>The difference between delirium and similar psychiatric illness<\/h3>\n<p>Delirium is a disorder that makes situational awareness and processing new information very difficult for those diagnosed. Delirium usually has a high rate of onset ranging from minutes to hours and sometimes days, but it does not last for very long, only a few hours to weeks. Delirium can also be accompanied by a shift in attention, mood swings, violent or unordinary behaviors, and hallucinations. Delirium may be caused by a preexisting medical condition. Delirium is noted by sudden changes in cognition. Alzheimer&#8217;s disease, depression, and some psychotic disorders tend to be more of a gradual cognition decline.<\/p>\n<table style=\"height: 248px;\">\n<caption>\u00a0<\/caption>\n<tbody>\n<tr style=\"height: 11px;\">\n<th style=\"height: 11px; width: 917.65px;\" colspan=\"5\">Table 1. Characteristics of delirium, Alzheimer&#8217;s disease, depression, and psychotic disorders<\/th>\n<\/tr>\n<tr style=\"height: 23px;\">\n<th style=\"height: 23px; width: 85.65px;\">Attributes<\/th>\n<th style=\"height: 23px; width: 220.85px;\">Delirium<\/th>\n<th style=\"height: 23px; width: 304.85px;\">Alzheimer&#8217;s disease<\/th>\n<th style=\"height: 23px; width: 162.45px;\">Depression<\/th>\n<th style=\"height: 23px; width: 99.25px;\">Psychotic Disorders<\/th>\n<\/tr>\n<tr style=\"height: 11px;\">\n<th style=\"height: 11px; width: 85.65px;\">Onset<\/th>\n<td style=\"height: 11px; width: 220.85px;\">Sudden\/acute\/subacute<\/td>\n<td style=\"height: 11px; width: 304.85px;\">Gradual<\/td>\n<td style=\"height: 11px; width: 162.45px;\">Gradual<\/td>\n<td style=\"height: 11px; width: 99.25px;\">Acute or gradual<\/td>\n<\/tr>\n<tr style=\"height: 23px;\">\n<th style=\"height: 23px; width: 85.65px;\">Progression<\/th>\n<td style=\"height: 23px; width: 220.85px;\">Shifts in severity, likely to resolve in days to weeks.<\/td>\n<td style=\"height: 23px; width: 304.85px;\">Worsens over a period of time<\/td>\n<td style=\"height: 23px; width: 162.45px;\">Acute or chronic with acute exacerbation<\/td>\n<td style=\"height: 23px; width: 99.25px;\">Chronic with acute exacerbation<\/td>\n<\/tr>\n<tr style=\"height: 23px;\">\n<th style=\"height: 23px; width: 85.65px;\">Hallucinations<\/th>\n<td style=\"height: 23px; width: 220.85px;\">May be present, mostly visual<\/td>\n<td style=\"height: 23px; width: 304.85px;\">Mostly absent (exceptions: Lewi body dementia, etc.)<\/td>\n<td style=\"height: 23px; width: 162.45px;\">May be present if associated with psychotic features<\/td>\n<td style=\"height: 23px; width: 99.25px;\">Present<\/td>\n<\/tr>\n<tr style=\"height: 11px;\">\n<th style=\"height: 11px; width: 85.65px;\">Delusions<\/th>\n<td style=\"height: 11px; width: 220.85px;\">Fleeting<\/td>\n<td style=\"height: 11px; width: 304.85px;\">Mostly not present<\/td>\n<td style=\"height: 11px; width: 162.45px;\">May be present<\/td>\n<td style=\"height: 11px; width: 99.25px;\">Present<\/td>\n<\/tr>\n<tr style=\"height: 23px;\">\n<th style=\"height: 23px; width: 85.65px;\">Psychomotor activity<\/th>\n<td style=\"height: 23px; width: 220.85px;\">Increased or decreased, may shift from increased to decreased states.<\/td>\n<td style=\"height: 23px; width: 304.85px;\">May or may not change<\/td>\n<td style=\"height: 23px; width: 162.45px;\">Change<\/td>\n<td style=\"height: 23px; width: 99.25px;\">Change<\/td>\n<\/tr>\n<tr style=\"height: 23px;\">\n<th style=\"height: 23px; width: 85.65px;\">Attention<\/th>\n<td style=\"height: 23px; width: 220.85px;\">Poor attention span and impaired short term memory.<\/td>\n<td style=\"height: 23px; width: 304.85px;\">Progressive worsening short-term memory. Attention span is likely to be affected in severe cases<\/td>\n<td style=\"height: 23px; width: 162.45px;\">May be altered<\/td>\n<td style=\"height: 23px; width: 99.25px;\">May be altered<\/td>\n<\/tr>\n<tr style=\"height: 11px;\">\n<th style=\"height: 11px; width: 85.65px;\">Consciousness<\/th>\n<td style=\"height: 11px; width: 220.85px;\">Altered, rapidly shifts<\/td>\n<td style=\"height: 11px; width: 304.85px;\">Mostly intact until severe stages<\/td>\n<td style=\"height: 11px; width: 162.45px;\">Normal<\/td>\n<td style=\"height: 11px; width: 99.25px;\">Normal<\/td>\n<\/tr>\n<tr style=\"height: 11px;\">\n<th style=\"height: 11px; width: 85.65px;\">Attention<\/th>\n<td style=\"height: 11px; width: 220.85px;\">Altered, rapidly shifts<\/td>\n<td style=\"height: 11px; width: 304.85px;\">Mostly intact until severe stages<\/td>\n<td style=\"height: 11px; width: 162.45px;\">May be altered<\/td>\n<td style=\"height: 11px; width: 99.25px;\">May be altered<\/td>\n<\/tr>\n<tr style=\"height: 11px;\">\n<th style=\"height: 11px; width: 85.65px;\">Orientation<\/th>\n<td style=\"height: 11px; width: 220.85px;\">Altered, rapidly shifts<\/td>\n<td style=\"height: 11px; width: 304.85px;\">Mostly intact until severe stages<\/td>\n<td style=\"height: 11px; width: 162.45px;\">Not altered<\/td>\n<td style=\"height: 11px; width: 99.25px;\">Not altered<\/td>\n<\/tr>\n<tr style=\"height: 23px;\">\n<th style=\"height: 23px; width: 85.65px;\">Speech<\/th>\n<td style=\"height: 23px; width: 220.85px;\">Not coherent<\/td>\n<td style=\"height: 23px; width: 304.85px;\">Errors<\/td>\n<td style=\"height: 23px; width: 162.45px;\">Slow<\/td>\n<td style=\"height: 23px; width: 99.25px;\">Normal or pressured<\/td>\n<\/tr>\n<tr style=\"height: 11px;\">\n<th style=\"height: 11px; width: 85.65px;\">Thought<\/th>\n<td style=\"height: 11px; width: 220.85px;\">Disorganized<\/td>\n<td style=\"height: 11px; width: 304.85px;\">Impoverished<\/td>\n<td style=\"height: 11px; width: 162.45px;\">Normal<\/td>\n<td style=\"height: 11px; width: 99.25px;\">Disorganized<\/td>\n<\/tr>\n<tr style=\"height: 11px;\">\n<th style=\"height: 11px; width: 85.65px;\">Perceptions<\/th>\n<td style=\"height: 11px; width: 220.85px;\">Altered, rapidly shifts<\/td>\n<td style=\"height: 11px; width: 304.85px;\">Mostly intact until severe stages<\/td>\n<td style=\"height: 11px; width: 162.45px;\">Normal<\/td>\n<td style=\"height: 11px; width: 99.25px;\">May be altered<\/td>\n<\/tr>\n<tr style=\"height: 11px;\">\n<th style=\"height: 11px; width: 85.65px;\">EEG<\/th>\n<td style=\"height: 11px; width: 220.85px;\">Moderate to severe background slowing<\/td>\n<td style=\"height: 11px; width: 304.85px;\">Normal or mild diffuse slowing<\/td>\n<td style=\"height: 11px; width: 162.45px;\">Normal<\/td>\n<td style=\"height: 11px; width: 99.25px;\">Normal<\/td>\n<\/tr>\n<tr style=\"height: 11px;\">\n<th style=\"height: 11px; width: 85.65px;\">Reversibility<\/th>\n<td style=\"height: 11px; width: 220.85px;\">Mostly<\/td>\n<td style=\"height: 11px; width: 304.85px;\">Very rarely<\/td>\n<td style=\"height: 11px; width: 162.45px;\">Yes<\/td>\n<td style=\"height: 11px; width: 99.25px;\">Rarely<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<p>&nbsp;<\/p>\n<\/div>\n<p>Delirium exists as a stage of consciousness somewhere in the spectrum between normal awake\/alert state and coma. While requiring an acute disturbance in\u00a0consciousness\/attention and\u00a0cognition, delirium is a syndrome encompassing an array of neuropsychiatric symptoms. Delirium arises through the interaction of a number of predisposing and precipitating factors.<\/p>\n<p>The most important predisposing factors are<\/p>\n<ul>\n<li>older age (&gt; 65 years old)<\/li>\n<li>male sex<\/li>\n<li>cognitive impairment \/\u00a0dementia<\/li>\n<li>physical comorbidity (biventricular failure,\u00a0cancer,\u00a0 and cerebrovascular disease)<\/li>\n<li>psychiatric comorbidity (e.g.,\u00a0depression)<\/li>\n<li>sensory impairment (vision, hearing)<\/li>\n<li>functional dependence (e.g., requiring assistance for self-care or mobility)<\/li>\n<li>dehydration\/malnutrition<\/li>\n<li>drugs and drug-dependence<\/li>\n<li>alcohol dependence<\/li>\n<\/ul>\n<p>Individuals with multiple and\/or significant predisposing factors are highly at risk for suffering an episode of delirium with a single and\/or mild precipitating factor. Conversely, delirium may only result in healthy individuals if they suffer serious or multiple precipitating factors. The factors affecting an individual may change over time, thus an individual\u2019s risk of delirium is dynamic.<\/p>\n<p>Some of the most common precipitating factors of delirium\u00a0are listed below:<\/p>\n<ul>\n<li>prolonged sleep deprivation<\/li>\n<li>environmental or physical\/psychological stress\n<ul>\n<li>inadequately controlled pain<\/li>\n<li>admission to an intensive care unit<\/li>\n<li>immobilization or use of physical restraints<\/li>\n<li>urinary retention or use of a bladder catheter<\/li>\n<li>emotional stress<\/li>\n<li>severe constipation and\/or fecal impaction<\/li>\n<\/ul>\n<\/li>\n<li>medications\n<ul>\n<li>sedatives (benzodiazepines,\u00a0opioids),\u00a0anticholinergics,\u00a0dopaminergics, corticosteroids,\u00a0polypharmacy<\/li>\n<li>general anesthetic<\/li>\n<li>substance intoxication or withdrawal<\/li>\n<\/ul>\n<\/li>\n<li>primary neurologic diseases\n<ul>\n<li>severe drop in blood pressure, relative to the patient\u2019s normal blood pressure (orthostatic hypotension) resulting in inadequate blood flow to the brain (cerebral hypoperfusion)<\/li>\n<li>stroke\/Transient ischemic attack (TIA)<\/li>\n<li>intracranial bleeding<\/li>\n<li>brain inflammation from meningitis or encephalitis<\/li>\n<\/ul>\n<\/li>\n<li>Concurrent illness\n<ul>\n<li>Infections \u2013 especially respiratory (e.g.\u00a0pneumonia) and\u00a0urinary tract infections<\/li>\n<li>Latrogenic\u00a0complications<\/li>\n<li>Hypoxia,\u00a0hypercapnea,\u00a0anemia<\/li>\n<li>Poor nutritional status, dehydration, electrolyte imbalances,\u00a0hypoglycemia<\/li>\n<li>Cardiac shock,\u00a0heart attacks,\u00a0heart failure<\/li>\n<li>Metabolic derangements (e.g.\u00a0SIADH,\u00a0Addison\u2019s disease,\u00a0hyperthyroidism)<\/li>\n<li>Chronic or terminal illness (e.g. cancer)<\/li>\n<li>Post-traumatic event (e.g. fall, fracture)<\/li>\n<\/ul>\n<\/li>\n<li>Surgery\n<ul>\n<li>Cardiac, orthopedic, prolonged\u00a0cardiopulmonary bypass, thoracic surgeries<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<p>The range of <strong><em>clinical features<\/em><\/strong> includes\u00a0poor attention\/vigilance\u00a0(100%), memory impairment (64\u2013100%), clouding of consciousness (45\u2013100%), disorientation (43\u2013100%), acute onset (93%), disorganized thinking\/thought disorder (59\u201395%), diffuse cognitive impairment (77%), language disorder (41\u201393%), sleep disturbance (25\u201396%),\u00a0mood lability\u00a0(43\u201363%), psychomotor changes (e.g. hyperactive, hypoactive, mixed) (38\u201355%), delusions (18\u201368%), and perceptual change\/hallucinations (17\u201355%).<\/p>\n<p>These various clinical features of delirium are further described below and can be assessed by several specialized tests, such as The Delirium Rating Scale-Revised-98 (DRS-R-98):<\/p>\n<div id=\"attachment_4525\" style=\"width: 228px\" class=\"wp-caption alignright\"><img loading=\"lazy\" decoding=\"async\" aria-describedby=\"caption-attachment-4525\" class=\"wp-image-4525\" src=\"https:\/\/s3-us-west-2.amazonaws.com\/courses-images\/wp-content\/uploads\/sites\/5351\/2020\/08\/18042205\/How_much_sleep_should_kids_get_120050450-221x300.jpg\" alt=\"A person in bed in an uncomfortable position.\" width=\"218\" height=\"296\" \/><\/p>\n<p id=\"caption-attachment-4525\" class=\"wp-caption-text\"><strong>Figure 2.<\/strong> Sleep disturbances and deprivation are risk factors for delirium.<\/p>\n<\/div>\n<ul>\n<li><em>Inattention<\/em>: As a required symptom to diagnose delirium, inattention is characterized by distractibility and an inability to shift and\/or sustain\u00a0attention.<\/li>\n<li><em>Memory impairment<\/em><span style=\"font-size: 1rem; text-align: initial;\">:\u00a0Memory impairment\u00a0is linked to inattention, especially reduced formation of new\u00a0<\/span><i style=\"font-size: 1rem; text-align: initial;\">long-term<\/i><span style=\"font-size: 1rem; text-align: initial;\">\u00a0memory where higher degrees of attention is more necessary than for short-term memory. Since older memories are retained without the need for concentration, previously formed long-term memories (i.e., those formed before the onset of delirium) are usually preserved in all but the most severe cases of delirium.<\/span><\/li>\n<li><em>Disorientation<\/em>:<span style=\"font-size: 1rem; text-align: initial;\">\u00a0As another symptom of confusion, and usually a more severe one, disorientation describes the loss of awareness of the surroundings, environment, and context in which the person exists. An individual may be disoriented to time, place, or self.<\/span><\/li>\n<li><em>Disorganized thinking<\/em><span style=\"font-size: 1rem; text-align: initial;\">:\u00a0Disorganized thinking\u00a0is usually noticed with speech that makes limited sense with apparent irrelevancies, and can involve\u00a0poverty of speech,\u00a0loose associations,\u00a0perseveration,\u00a0tangentiality, and other signs of a formal thought disorder.<\/span><\/li>\n<li><em>Language disturbances<\/em><span style=\"font-size: 1rem; text-align: initial;\"><span style=\"font-size: 1rem; text-align: initial;\">:\u00a0Anomic aphasia,\u00a0paraphasia, impaired comprehension,\u00a0agraphia, and word-finding diffi<\/span><\/span>culties all involve impairment of linguistic information processing.<\/li>\n<li><em>Sleep changes<\/em><span style=\"font-size: 1rem; text-align: initial;\">: Sleep disturbances in delirium reflect disturbed circadian rhythm regulation, typically involving fragmented sleep or even sleep-wake cycle reversal (i.e., active at night and sleeping during the day) and often preceding the onset of a delirium episode<\/span><\/li>\n<li><em>Psychotic symptoms<\/em>:<span style=\"font-size: 1rem; text-align: initial;\">\u00a0Symptoms of\u00a0psychosis\u00a0include suspiciousness, overvalued ideation, and frank delusions.\u00a0Delusions\u00a0are typically poorly formed and less\u00a0stereotyped\u00a0than in schizophrenia or Alzheimer\u2019s disease. The delusions usually relate to persecutory themes of impending danger or threat in the immediate environment (e.g., being poisoned by nurses).<\/span><\/li>\n<li><em>Mood lability<\/em><span style=\"font-size: 1rem; text-align: initial;\">: Distortions to perceived or communicated emotional states as well as\u00a0fluctuating emotional states\u00a0can manifest in a delirious person (e.g., rapid changes between terror, sadness, and joking).<\/span><\/li>\n<li><em>Motor activity changes<\/em>:<span style=\"font-size: 1rem; text-align: initial;\">\u00a0Delirium has been commonly classified into psychomotor subtypes of hypoactive, hyperactive, and mixed,\u00a0though studies are inconsistent as to the prevalence of these subtypes.\u00a0Hypoactive cases are prone to non-detection or misdiagnosis as depression. A range of studies suggest that motor subtypes differ regarding underlying pathophysiology, treatment needs, and prognosis for function and mortality though inconsistent subtype definitions and poorer detection of hypoactive subtypes impact the interpretation of these findings.<\/span><\/li>\n<\/ul>\n<p>Treatment of delirium requires identifying and managing the underlying causes, managing delirium symptoms, and reducing the risk of complications.\u00a0In some cases, temporary or symptomatic treatments are used to comfort the person or to facilitate other care (e.g., preventing people from pulling out a breathing tube).\u00a0Antipsychotics\u00a0are not supported for the treatment or prevention of delirium among those who are in hospital.\u00a0When delirium is caused by alcohol or\u00a0sedative-hypnotic\u00a0withdrawal,\u00a0benzodiazepines\u00a0are typically used. Evidence has found that the risk of delirium in hospitalized people can be reduced by systematic good general care.\u00a0Delirium affects 14\u201324% of all hospitalized individuals. The overall prevalence for the general population is 1%-2% but this prevalence increases with age, reaching 14% of adults over age 85. Among older adults, delirium occurs in 15\u201353% of those post-surgery, 70\u201387% of those in the\u00a0ICU, up to 60% of those in nursing homes or post-acute care settings.\u00a0Among individuals requiring critical care, delirium is a risk for death within the next year.<\/p>\n<h2><span id=\"Prevention\" class=\"mw-headline\">Prevention<\/span><\/h2>\n<p>There is substantial evidence that delirium results in long-term poor outcomes in older persons admitted to hospital.\u00a0Recent long-term studies showed that many patients still meet the criteria for delirium for a prolonged period after hospital discharge, with up to 21% of patients showing persistent delirium at six months post-discharge.<\/p>\n<p>Using a tailored multifaceted approach clinicians can decrease rates of delirium by 27% among the elderly.\u00a0At least 30\u201340% of all cases of delirium could be prevented, and high rates of delirium reflect negatively on the quality of care.\u00a0Episodes of delirium can be prevented by identifying hospitalized people at risk of the condition: those over age 65, those with a known cognitive impairment, those with\u00a0hip fracture, those with severe illness.<\/p>\n<p>Delirium may be prevented and treated by using non-pharmacologic approaches focused on risk factors, such as constipation, dehydration, low oxygen levels, immobility, visual or hearing impairment, sleep deprivation, functional decline, and removing or minimizing problematic medications.<sup id=\"cite_ref-NICE_59-1\" class=\"reference\"><\/sup>\u00a0Ensuring a therapeutic environment (e.g., individualized care; clear communication; adequate reorientation and lighting during daytime; promoting uninterrupted\u00a0sleep hygiene\u00a0with minimal noise and light at night; minimizing bed relocation; having familiar objects like family pictures; providing earplugs; and providing adequate nutrition, pain control, and assistance toward early mobilization) can also yield benefit toward preventing delirium.<sup id=\"cite_ref-Siddiqi2016_4-1\" class=\"reference\"><\/sup><sup id=\"cite_ref-Inouye2006_20-2\" class=\"reference\"><\/sup><sup id=\"cite_ref-60\" class=\"reference\"><\/sup>\u00a0Research into pharmacologic prevention and treatment is weak and insufficient to make proper recommendations.<\/p>\n<div class=\"textbox examples\">\n<h3>watch It<\/h3>\n<p>This video provides an overview of the causes, symptoms, diagnosis, and treatment of delirium.<\/p>\n<p><iframe loading=\"lazy\" id=\"oembed-1\" title=\"Delirium - causes, symptoms, diagnosis, treatment &amp; pathology\" width=\"500\" height=\"281\" src=\"https:\/\/www.youtube.com\/embed\/qmMYsVaZ0zo?feature=oembed&#38;rel=0\" frameborder=\"0\" allowfullscreen=\"allowfullscreen\"><\/iframe><\/p>\n<p>You can view the <a href=\"https:\/\/course-building.s3-us-west-2.amazonaws.com\/Abnormal+Psychology\/transcripts\/DeliriumCausesSymptomsDiagnosis_transcript.txt\" target=\"_blank\" rel=\"noopener\">transcript for &#8220;Delirium &#8211; causes, symptoms, diagnosis, treatment &amp; pathology&#8221; here (opens in new window)<\/a>.<\/p>\n<\/div>\n<div class=\"textbox key-takeaways\">\n<h3>Key Takeaways: Delirium<\/h3>\n<p><iframe loading=\"lazy\" title=\"69. Delirium\" src=\"https:\/\/lumenlearning.h5p.com\/content\/1291236408646173468\/embed\" width=\"1088\" height=\"859\" frameborder=\"0\" allowfullscreen=\"allowfullscreen\"><\/iframe><script src=\"https:\/\/lumenlearning.h5p.com\/js\/h5p-resizer.js\" charset=\"UTF-8\"><\/script><\/p>\n<\/div>\n<div class=\"textbox tryit\">\n<h3>Try It<\/h3>\n<p>\t<iframe id=\"assessment_practice_f9e64bf9-8ef8-4b9d-85d0-7daae9a6468d\" class=\"resizable\" src=\"https:\/\/assess.lumenlearning.com\/practice\/f9e64bf9-8ef8-4b9d-85d0-7daae9a6468d?iframe_resize_id=assessment_practice_id_f9e64bf9-8ef8-4b9d-85d0-7daae9a6468d\" frameborder=\"0\" style=\"border:none;width:100%;height:100%;min-height:300px;\"><br \/>\n\t<\/iframe><\/p>\n<p>\t<iframe id=\"assessment_practice_c6dbc950-6451-4655-a654-602122dc3fac\" class=\"resizable\" src=\"https:\/\/assess.lumenlearning.com\/practice\/c6dbc950-6451-4655-a654-602122dc3fac?iframe_resize_id=assessment_practice_id_c6dbc950-6451-4655-a654-602122dc3fac\" frameborder=\"0\" style=\"border:none;width:100%;height:100%;min-height:300px;\"><br \/>\n\t<\/iframe><\/p>\n<\/div>\n<div class=\"textbox learning-objectives\">\n<h3>Glossary<\/h3>\n<p><b>delirium:<\/b>\u00a0an organically caused decline from a previous baseline mental functioning that develops over a short period of time, typically hours to days<\/p>\n<\/div>\n\n\t\t\t <section class=\"citations-section\" role=\"contentinfo\">\n\t\t\t <h3>Candela Citations<\/h3>\n\t\t\t\t\t <div>\n\t\t\t\t\t\t <div id=\"citation-list-1087\">\n\t\t\t\t\t\t\t <div class=\"licensing\"><div class=\"license-attribution-dropdown-subheading\">CC licensed content, Original<\/div><ul class=\"citation-list\"><li>Modification, adaptation, and original content. <strong>Authored by<\/strong>: Bob Hoople for Lumen Learning. <strong>Provided by<\/strong>: Lumen Learning. <strong>License<\/strong>: <em><a target=\"_blank\" rel=\"license\" href=\"https:\/\/creativecommons.org\/licenses\/by-sa\/4.0\/\">CC BY-SA: Attribution-ShareAlike<\/a><\/em><\/li><\/ul><div class=\"license-attribution-dropdown-subheading\">CC licensed content, Shared previously<\/div><ul class=\"citation-list\"><li>Delirium. <strong>Provided by<\/strong>: Wikipedia. <strong>Located at<\/strong>: <a target=\"_blank\" href=\"https:\/\/en.wikipedia.org\/wiki\/Delirium\">https:\/\/en.wikipedia.org\/wiki\/Delirium<\/a>. <strong>License<\/strong>: <em><a target=\"_blank\" rel=\"license\" href=\"https:\/\/creativecommons.org\/licenses\/by-sa\/4.0\/\">CC BY-SA: Attribution-ShareAlike<\/a><\/em><\/li><li>Sleep deprivation. <strong>Authored by<\/strong>: Lumia13. <strong>Located at<\/strong>: <a target=\"_blank\" href=\"https:\/\/commons.wikimedia.org\/wiki\/File:How_much_sleep_should_kids_get_120050450.jpg\">https:\/\/commons.wikimedia.org\/wiki\/File:How_much_sleep_should_kids_get_120050450.jpg<\/a>. <strong>License<\/strong>: <em><a target=\"_blank\" rel=\"license\" href=\"https:\/\/creativecommons.org\/licenses\/by-sa\/4.0\/\">CC BY-SA: Attribution-ShareAlike<\/a><\/em><\/li><li>Delirium. <strong>Provided by<\/strong>: Wikipedia. <strong>Located at<\/strong>: <a target=\"_blank\" href=\"https:\/\/en.wikipedia.org\/wiki\/Delirium\">https:\/\/en.wikipedia.org\/wiki\/Delirium<\/a>. <strong>License<\/strong>: <em><a target=\"_blank\" rel=\"license\" href=\"https:\/\/creativecommons.org\/licenses\/by-sa\/4.0\/\">CC BY-SA: Attribution-ShareAlike<\/a><\/em><\/li><\/ul><div class=\"license-attribution-dropdown-subheading\">All rights reserved content<\/div><ul class=\"citation-list\"><li>Delirium - causes, symptoms, diagnosis, treatment &amp; pathology. <strong>Provided by<\/strong>: Osmosis. <strong>Located at<\/strong>: <a target=\"_blank\" href=\"https:\/\/www.youtube.com\/watch?v=qmMYsVaZ0zo&#038;feature=emb_logo\">https:\/\/www.youtube.com\/watch?v=qmMYsVaZ0zo&#038;feature=emb_logo<\/a>. <strong>License<\/strong>: <em>Other<\/em>. <strong>License Terms<\/strong>: Standard YouTube License<\/li><\/ul><div class=\"license-attribution-dropdown-subheading\">Public domain content<\/div><ul class=\"citation-list\"><li>Delirium image. <strong>Provided by<\/strong>: Wikipedia. <strong>Located at<\/strong>: <a target=\"_blank\" href=\"https:\/\/en.wikipedia.org\/wiki\/Delirium#\/media\/File:Mental_diseases._A_text-book_of_psychiatry_for_medical_students_and_practitioners_(1913)_(14592098880).jpg\">https:\/\/en.wikipedia.org\/wiki\/Delirium#\/media\/File:Mental_diseases._A_text-book_of_psychiatry_for_medical_students_and_practitioners_(1913)_(14592098880).jpg<\/a>. <strong>License<\/strong>: <em><a target=\"_blank\" rel=\"license\" href=\"https:\/\/creativecommons.org\/about\/pdm\">Public Domain: No Known Copyright<\/a><\/em><\/li><\/ul><\/div>\n\t\t\t\t\t\t <\/div>\n\t\t\t\t\t <\/div>\n\t\t\t <\/section>","protected":false},"author":29,"menu_order":4,"template":"","meta":{"_candela_citation":"[{\"type\":\"pd\",\"description\":\"Delirium image\",\"author\":\"\",\"organization\":\"Wikipedia\",\"url\":\"https:\/\/en.wikipedia.org\/wiki\/Delirium#\/media\/File:Mental_diseases._A_text-book_of_psychiatry_for_medical_students_and_practitioners_(1913)_(14592098880).jpg\",\"project\":\"\",\"license\":\"pd\",\"license_terms\":\"\"},{\"type\":\"cc\",\"description\":\"Delirium\",\"author\":\"\",\"organization\":\"Wikipedia\",\"url\":\"https:\/\/en.wikipedia.org\/wiki\/Delirium\",\"project\":\"\",\"license\":\"cc-by-sa\",\"license_terms\":\"\"},{\"type\":\"cc\",\"description\":\"Sleep deprivation\",\"author\":\"Lumia13\",\"organization\":\"\",\"url\":\"https:\/\/commons.wikimedia.org\/wiki\/File:How_much_sleep_should_kids_get_120050450.jpg\",\"project\":\"\",\"license\":\"cc-by-sa\",\"license_terms\":\"\"},{\"type\":\"cc\",\"description\":\"Delirium\",\"author\":\"\",\"organization\":\"Wikipedia\",\"url\":\"https:\/\/en.wikipedia.org\/wiki\/Delirium\",\"project\":\"\",\"license\":\"cc-by-sa\",\"license_terms\":\"\"},{\"type\":\"original\",\"description\":\"Modification, adaptation, and original content\",\"author\":\"Bob Hoople for Lumen Learning\",\"organization\":\"Lumen Learning\",\"url\":\"\",\"project\":\"\",\"license\":\"cc-by-sa\",\"license_terms\":\"\"},{\"type\":\"copyrighted_video\",\"description\":\"Delirium - causes, symptoms, diagnosis, treatment & pathology\",\"author\":\"\",\"organization\":\"Osmosis\",\"url\":\"https:\/\/www.youtube.com\/watch?v=qmMYsVaZ0zo&feature=emb_logo\",\"project\":\"\",\"license\":\"other\",\"license_terms\":\"Standard YouTube License\"}]","CANDELA_OUTCOMES_GUID":"eb4cc245-47ea-4050-b6b1-c8b35569e817, 00e3d601-044a-4933-9c2e-02494239ebea","pb_show_title":"on","pb_short_title":"","pb_subtitle":"","pb_authors":[],"pb_section_license":""},"chapter-type":[],"contributor":[],"license":[],"class_list":["post-1087","chapter","type-chapter","status-publish","hentry"],"part":158,"_links":{"self":[{"href":"https:\/\/courses.lumenlearning.com\/wm-abnormalpsych\/wp-json\/pressbooks\/v2\/chapters\/1087","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/courses.lumenlearning.com\/wm-abnormalpsych\/wp-json\/pressbooks\/v2\/chapters"}],"about":[{"href":"https:\/\/courses.lumenlearning.com\/wm-abnormalpsych\/wp-json\/wp\/v2\/types\/chapter"}],"author":[{"embeddable":true,"href":"https:\/\/courses.lumenlearning.com\/wm-abnormalpsych\/wp-json\/wp\/v2\/users\/29"}],"version-history":[{"count":33,"href":"https:\/\/courses.lumenlearning.com\/wm-abnormalpsych\/wp-json\/pressbooks\/v2\/chapters\/1087\/revisions"}],"predecessor-version":[{"id":7554,"href":"https:\/\/courses.lumenlearning.com\/wm-abnormalpsych\/wp-json\/pressbooks\/v2\/chapters\/1087\/revisions\/7554"}],"part":[{"href":"https:\/\/courses.lumenlearning.com\/wm-abnormalpsych\/wp-json\/pressbooks\/v2\/parts\/158"}],"metadata":[{"href":"https:\/\/courses.lumenlearning.com\/wm-abnormalpsych\/wp-json\/pressbooks\/v2\/chapters\/1087\/metadata\/"}],"wp:attachment":[{"href":"https:\/\/courses.lumenlearning.com\/wm-abnormalpsych\/wp-json\/wp\/v2\/media?parent=1087"}],"wp:term":[{"taxonomy":"chapter-type","embeddable":true,"href":"https:\/\/courses.lumenlearning.com\/wm-abnormalpsych\/wp-json\/pressbooks\/v2\/chapter-type?post=1087"},{"taxonomy":"contributor","embeddable":true,"href":"https:\/\/courses.lumenlearning.com\/wm-abnormalpsych\/wp-json\/wp\/v2\/contributor?post=1087"},{"taxonomy":"license","embeddable":true,"href":"https:\/\/courses.lumenlearning.com\/wm-abnormalpsych\/wp-json\/wp\/v2\/license?post=1087"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}