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Delirium

  • Oliver Freudenreich
Chapter
Part of the Current Clinical Psychiatry book series (CCPSY)

Abstract

Delirium (acute brain failure or acute confusional state) is a clinical syndrome that is always due to a medical condition, usually more than one. A correct diagnosis of delirium is needed to offer treatment directed at the underlying cause(s). Hallmark symptoms of delirium (inattention, altered consciousness, disordered thinking, fluctuating mental state) can be overshadowed by psychosis and catatonia which can lead to a missed delirium diagnosis. This chapter reviews the clinical diagnosis of a delirium, its medical work-up, treatment (antipsychotics including intravenous haloperidol), and prevention. Psychiatric conditions that can be confused with a delirium or predispose to a delirium are discussed.

Keywords

Delirium Diagnosis Differential diagnosis Medical work-up Treatment Prevention Intravenous haloperidol 

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Additional Resources

    Book Chapter

    1. Caplan JP. Delirious patients. In: Stern TA, Freudenreich O, Smith FA, Fricchione GL, Rosenbaum JF, editors. Massachusetts General Hospital handbook of general hospital psychiatry. 7th ed. Edinburgh: Elsevier; 2018. p. 83–93. – From my department’s book on General Hospital Psychiatry. The CL service at MGH has extensive experience with the management of delirium, and this chapter contains detailed instructions about how to optimally treat a delirium, including IV haloperidol.Google Scholar

    Articles

    1. Inouye SK, Westendorp RG, Saczynski JS. Delirium in elderly people. Lancet. 2014;383:911–22. – Excellent conceptual overview of delirium by one of the pioneers in delirium research.CrossRefGoogle Scholar
    2. Oldham MA, Flanagan NM, Khan A, Boukrina O, Marcantonio ER. Responding to ten common delirium misconceptions with best evidence: an educational review for clinicians. J Neuropsychiatry Clin Neurosci. 2018;30:51–7. – Readable and practical guide for clinicians that corrects commonly held misconceptions about delirium.CrossRefGoogle Scholar
    3. Hall W, Zador D, et al. Lancet. 1997;349:1897–900. – Remains one of the best articles on the basic principles of alcohol withdrawal, which I did not cover in this chapter.CrossRefGoogle Scholar
    4. Stern TA, Celano CM, Gross AF, Huffman JC, Freudenreich O, Kontos N, et al. The assessment and management of agitation and delirium in the general hospital. Prim Care Companion J Clin Psychiatry. 2010;12:PCC 09r00938. – A clinical article about the diagnosis and treatment of agitation and delirium in the general medical hospital.PubMedPubMedCentralGoogle Scholar
    5. Wu YC, Tseng PT, Tu YK, Hsu CY, Liang CS, Yeh TC, et al. Association of delirium response and safety of pharmacological interventions for the management and prevention of delirium: a network meta-analysis. JAMA Psychiat. 2019;76:526–35. – If you like network meta-analyses, here are the results from one: haloperidol plus lorazepam worked best for the treatment of delirium, ramelteon for its prevention.CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2020

Authors and Affiliations

  • Oliver Freudenreich
    • 1
  1. 1.Department of PsychiatryMassachusetts General HospitalBostonUSA

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