1. What is delirium and what are its key characteristics?
Delirium, also known as acute confusional state, is a sudden-onset syndrome marked by impaired consciousness and cognitive dysfunction. According to ICD-10, it results from systemic causes leading to brain malfunction. Symptoms fluctuate and may persist for days or, in chronic cases, up to six months.
2. What are the common causes of delirium?
Delirium arises from systemic illnesses and can be triggered by:
- Infections
- Neoplasms
- Head trauma
- Metabolic or endocrine disorders
- Cardiovascular and respiratory conditions
- Organ failure
- Intracranial causes
- Medications, toxins, or substance withdrawal
- Postoperative states
3. What are the clinical features of delirium?
Key signs include:
- Disturbed consciousness and attention
- Disorientation, poor memory and concentration
- Visual hallucinations and illusions
- Muddled thinking, incoherent speech
- Psychomotor changes: hypo- or hyperactivity
- Disrupted sleep-wake cycle
- Emotional disturbances: fear, anxiety, euphoria, or apathy
4. How is delirium differentiated from dementia?
| Feature | Delirium | Dementia |
|---|---|---|
| Onset | Acute | Gradual |
| Symptom course | Fluctuating | Progressive |
| Hallucinations | Common (visual) | Rare (unless Lewy body dementia) |
| Disorientation | Early and prominent | Late feature |
| Physical illness | Usually present | May or may not be |
5. How to differentiate delirium from psychiatric illness?
Unlike primary psychiatric illnesses:
- Delirium presents with disorientation, visual hallucinations, and underlying medical illness (e.g., fever, focal signs).
- Psychiatric disorders like schizophrenia may involve auditory hallucinations, delusions, and a psychiatric history.
6. How is delirium managed?
Management includes:
- Treating the underlying cause
- Supportive care: hydration, nutrition, safe environment, reorientation
- Pharmacologic therapy (if needed): antipsychotics for agitation or hallucinations
- Avoid unnecessary stimuli and ensure frequent reorientation
7. Where should a patient with delirium be treated?
Delirium is managed in:
- Medical or surgical units
- ICUs for severe cases
- Avoid psychiatric wards unless there’s a primary psychiatric component. Liaison psychiatry support is often helpful.
8. What are the goals of assessing a delirious patient?
The two main objectives:
- Confirm the diagnosis of delirium
- Identify the underlying cause
9. What investigations are done in suspected delirium?
First-line tests:
- FBC, ESR, U&E, creatinine, FBS
- LFTs, chest X-ray, ECG
- Urine full report and culture
Second-line (if needed):
- EEG, CT/MRI brain
- Lumbar puncture, HIV/VDRL testing
- Urine drug screen, serology, cultures
10. What medications are used for pharmacological management?
- Haloperidol: First-line antipsychotic (low doses, especially in elderly)
- Second-generation antipsychotics: Risperidone, Olanzapine, Quetiapine
- Benzodiazepines: Indicated for alcohol withdrawal delirium (delirium tremens)
Read : Confusion vs. Delirium vs. Dementia: Clinical Differences You Should Know