Learn About Delirium
Delirium is sudden severe confusion due to rapid changes in brain function that can occur with physical or mental illness.
Acute confusional state; Acute brain syndrome
Delirium is most often caused by physical or mental illness and is usually temporary and reversible. Many disorders may cause delirium. Often, these disorders do not allow the brain to get oxygen or other substances. They may also cause dangerous chemicals (toxins) to build up in the brain. Delirium is common in the intensive care unit (ICU), especially in older adults.
Causes include:
- Alcohol or medicine overdose or withdrawal
- Drug use or overdose, including being sedated in the ICU
- Electrolyte or other body chemical disturbances
- Infections such as urinary tract infections, pneumonia, or meningitis
- Severe lack of sleep
- Poisons
- General anesthesia and surgery
- Autoimmune disease
Delirium involves a quick change between mental states (for example, from lethargy to agitation and back to lethargy).
Symptoms include:
- Changes in alertness (usually more alert in the morning, less alert at night)
- Changes in feeling (sensation) and perception
- Changes in level of consciousness or awareness
- Changes in movement (for example, may be slow moving or hyperactive)
- Changes in sleep patterns, drowsiness
- Confusion (disorientation) about time or place
- Decrease in short-term memory and recall
- Disorganized thinking, such as talking in a way that doesn't make sense
- Emotional or personality changes, such as anger, agitation, depression, irritability, and overly happy
- Incontinence
- Movements triggered by changes in the nervous system
- Problem concentrating
The goal of treatment is to control or reverse the cause of the symptoms. Treatment depends on the condition causing delirium. The person may need to stay in the hospital for a short time.
Stopping or changing medicines that may worsen confusion, or that are no longer needed, may improve mental function.
Disorders that contribute to confusion should be treated. These may include:
- Anemia
- Decreased oxygen (hypoxia)
- Heart failure
- High carbon dioxide levels (hypercapnia)
- Infections
- Kidney failure
- Liver failure
- Metabolic disorders
- Nutritional disorders
- Psychiatric conditions (such as depression or psychosis)
- Thyroid disorders
Treating medical and mental disorders often greatly improves mental function.
Medicines may be needed to control aggressive or agitated behaviors. These are usually started at very low dosages and adjusted as needed.
Some people with delirium may benefit from hearing aids, glasses, or cataract surgery.
Other treatments that may be helpful:
- Behavior modification to control unacceptable or dangerous behaviors
- Reality orientation to reduce disorientation
Johns Hopkins Bayview Medical Center
Dr. Esther Oh is a Professor of Medicine, Psychiatry and Behavioral Sciences and Pathology at the Johns Hopkins University School of Medicine. Her areas of clinical expertise is in evaluation and management of memory disorders. She has an extensive experience in evaluating memory disorders in older adults with multiple chronic diseases, and takes and integrative approach in the treatment of memory disorders. Dr. Oh also serves as the co-director of the Johns Hopkins Memory and Alzheimer’s Treatment Center. Dr. Oh earned her M.D. from the UHS/Chicago Medical School. She completed her residency in internal medicine at the University of Illinois at Chicago where she was a chief resident. She completed a fellowship in geriatric medicine and gerontology at Johns Hopkins University School of Medicine, and received her Ph.D. from the Johns Hopkins Bloomberg School of Public Health. Dr. Oh has received numerous awards including the Merck New Investigator Award, AFAR New Investigator Award in Alzheimer’s disease, and the Johns Hopkins Clinical Research Scholars Award. She is also a recipient of several major grants from the National Institute on Aging (NIA). She has also been honored for her teaching by Excellence in Teaching Award in the Division of Geriatric Medicine and Gerontology in 2013 and 2017. Dr. Oh’s research is primarily focused on Alzheimer’s disease and related disorders. Her current projects include: development of biomarkers for detecting early stages of Alzheimer’s disease; understanding the interrelationship between delirium and Alzheimer’s disease; cognitive changes after surgery; and understanding the role of sensory problems (hearing and vestibular function) in Alzheimer’s disease. Dr. Oh is rated as an Elite provider by MediFind in the treatment of Delirium. Her top areas of expertise are Delirium, Alzheimer's Disease, Dementia, Deep Brain Stimulation, and Liver Transplant.
UPMC Neurological Institute - Presbyterian
David Okonkwo is a Neurosurgery provider in Pittsburgh, Pennsylvania. Dr. Okonkwo is rated as a Distinguished provider by MediFind in the treatment of Delirium. His top areas of expertise are Subdural Hematoma, Scoliosis, Chronic Subdural Hematoma, Gastrostomy, and Microdiscectomy. Dr. Okonkwo is currently accepting new patients.
Advocate Medical Group General Surgery
Marin Marinov is a General Surgeon in Park Ridge, Illinois. Dr. Marinov is rated as a Distinguished provider by MediFind in the treatment of Delirium. His top areas of expertise are Delirium, Gallbladder Disease, Gallstones, Hernia Surgery, and Colostomy.
Acute conditions that cause delirium may occur with long-term (chronic) disorders that cause dementia. Acute brain syndromes may be reversible by treating the cause.
Delirium often lasts about 1 week. It may take several weeks for mental function to return to normal. Full recovery is usually expected, but depends on the underlying cause of the delirium.
Problems that may result from delirium include:
- Loss of ability to function or care for self
- Loss of ability to interact
- Progression to stupor or coma
- Side effects of medicines used to treat the disorder
Contact your health care provider if there is a rapid change in mental status.
Treating the conditions that cause delirium can reduce its risk. In hospitalized people, avoiding or using a low dosage of sedatives, prompt treatment of metabolic disorders and infections, and using reality orientation programs will reduce the risk of delirium in those at high risk.
Objectives: The study aims to enhance the assessment of children's outcomes and experiences in perioperative settings, ultimately improving pediatric perioperative healthcare. The objectives include: 1. Translation and Adaptation: a. Translate and adapt the PedSQoR for Danish children aged 4-12. b. Validate the Danish PedSQoR version. 2. Development of a PREM Instrument: a. Develop a comprehensive PREM for ch...
Summary: Postoperative delirium (POD) is an acute brain dysfunction characterized by inattention, impaired consciousness, and cognitive and orientation disturbances, and is a common complication after cardiac surgery. The high incidence of up to 52% of POD in cardiac surgery patients lead to a range of adverse clinical outcomes.The brain tissue is enclosed in a rigid anatomical structure; when there is an ...
Published Date: December 31, 2023
Published By: Joseph V. Campellone, MD, Department of Neurology, Cooper Medical School at Rowan University, Camden, NJ. Review provided by VeriMed Healthcare Network. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.
Inouye SK. Delirium and changes in mental status. In: Goldman L, Cooney K, eds. Goldman-Cecil Medicine. 27th ed. Philadelphia, PA: Elsevier; 2024:chap 361.
Mendez MF, Yerstein O. Delirium. In: Jankovic J, Mazziotta JC, Pomeroy SL, Newman NJ, eds. Bradley's and Daroff's Neurology in Clinical Practice. 8th ed. Philadelphia, PA: Elsevier; 2022:chap 4.