TAILIEUCHUNG - Chapter 026. Confusion and Delirium

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. . | Chapter 026. Confusion and Delirium 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 sleep-wake 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 In striking contrast is the hypoactive subtype of delirium exemplified by opiate intoxication in which patients are withdrawn and quiet with prominent apathy and psychomotor slowing. This dichotomy between subtypes of delirium is a useful construct but patients often fall somewhere along a spectrum between the hyperactive and hypoactive extremes sometimes fluctuating from one to the other within minutes. Therefore clinicians must recognize the broad range of presentations of delirium in order to identify all patients with this potentially reversible cognitive disturbance. Hyperactive patients such as those with delirium tremens are easily recognized by their characteristic severe agitation tremor hallucinations and autonomic instability. Patients who are .

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