ACUTE CONFUSIONAL STATE

ACUTE CONFUSIONAL STATEDefinition

Delirium ( acute confusional state ) defined as an acute disorder of attention and global cognitive function(Hazzard)

Delirium often initiates a cascade of events in older persons, leading to a downward spiral of functional decline, loss of independence, institutionalization, and ultimately, death. (Hazzard)

EtiologyMultifactorialinterrelationship between patient vulnerability (i.e., predisposing factors) and the occurrence of noxious insults (i.e., precipitating factors).l

TABLE 53-1Diagnostic Criteria for DeliriumDiagnostic and Statistical Manual (DSM-IV) Diagnostic CriteriaA. A disturbance of consciousness (i.e., reduced awareness of the external environment) with reduced ability to focus, sustain, or shift attention.B. A change in cognition (such as memory deficit, disorientation, language disturbance) or the development of a perceptual disturbance that is notbetter accounted for by a preexisting dementia.C. The disturbance develops over a short period of time (usually hours to days) and tends to fluctuate over the course of a 24-hour period.D. Evidence from the history, physical examination, or laboratory findings that the disturbance is caused by an underlying organic condition or isthe direct physiologic consequences of a general medical condition or its treatment.The Confusion Assessment Method (CAM) Diagnostic Algorithm

overviewDelirium is common in older people, but is often not recognisedIt can present with a wide range of symptoms and signs Patients at high risk of developing delirium can be identifi ed and it can sometimes be prevented Treatment of delirium involves environmental measures as well as treatment of the underlying cause Pharmacological treatment with sedatives or antipsychotic medication is a last resort

Common causes of delirium

Changes delirium