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Harrison's Internal Medicine Chapter 26. Confusion and Delirium Confusion and Delirium: Introduction Confusion, a mental and behavioral state of reduced comprehension, coherence, and capacity to reason, is one of the most common problems encountered in medicine, accounting for a large number of emergency department visits, hospital admissions, and inpatient consultations. Delirium, a term used to describe an acute confusional state, remains a major cause of morbidity and mortality, contributing billions of dollars yearly to health care costs in the United States alone. Delirium often goes unrecognized despite clear evidence that it is usually the cognitive manifestation of serious underlying. | Chapter 026. Confusion and Delirium Part 1 Harrison s Internal Medicine Chapter 26. Confusion and Delirium Confusion and Delirium Introduction Confusion a mental and behavioral state of reduced comprehension coherence and capacity to reason is one of the most common problems encountered in medicine accounting for a large number of emergency department visits hospital admissions and inpatient consultations. Delirium a term used to describe an acute confusional state remains a major cause of morbidity and mortality contributing billions of dollars yearly to health care costs in the United States alone. Delirium often goes unrecognized despite clear evidence that it is usually the cognitive manifestation of serious underlying medical or neurologic illness. Clinical Features of Delirium A multitude of terms are used to describe delirium including encephalopathy acute brain failure acute confusional state and postoperative or intensive care unit ICU psychosis. Delirium has many clinical manifestations but essentially it is defined as a relatively acute decline in cognition that fluctuates over hours or days. The hallmark of delirium is a deficit of attention although all cognitive domains including memory executive function visuospatial tasks and language are variably involved. Associated symptoms may include altered sleepwake cycles perceptual disturbances such as hallucinations or delusions affect changes and autonomic findings including heart rate and blood pressure instability. Delirium is a clinical diagnosis that can only be made at the bedside. Two broad clinical categories of delirium have been described hyperactive and hypoactive subtypes based on differential psychomotor features. The cognitive syndrome associated with severe alcohol withdrawal remains the classic example of the hyperactive subtype featuring prominent hallucinations agitation and hyperarousal often accompanied by life-threatening autonomic instability. In striking contrast is the hypoactive .
