Clinical Features of Delirium

A. Delirium is characterized by impairments of consciousness, awareness of environment, attention and concentration. Many patients are disoriented and display disorganized thinking. A fluctuating clinical presentation is the hallmark of the disorder, and the patient may have moments of lucidity during the course of the day.

B. Perceptual disturbances may take the form of misinterpretations, illusions or frank hallucinations. The hallucinations are most commonly visual in nature, but other sensory modalities can also be misperceived.

C. Sleep-wake cycle disturbances are common, and psychomotor agitation can be severe, resulting in pulling out IVS and catheters, falling, and combative behavior. The quietly delirious patient may reduce fluid and food intake without overtly displaying agitated behavior.

D. Failure to report use of medications or substance abuse is a common cause of withdrawal delirium in hospitalized patients. Infection and medication interaction or toxicity is a common cause of delirium in the elderly.

E. Delirium is associated with increased morbidity and mortality because injuries may occur when the patient is delirious and agitated and unrecognized delirium may result in permanent cognitive impairment.

F. The incidence of delirium in hospitalized patients is 10-15%, with higher rates in the elderly. Other patients at risk include those with known CNS disorders, substance abusers, and HIV-positive patients.

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