Management of Delirium

Abstract

Delirium is categorized in the cognitive disorders, characterized by acute onset, global impairment in cognitive, emotional, mental, and behavioral functioning, fluctuating level of consciousness, attention impairment, decreased or increased psychomotor activity and the disturbance of sleep-wake cycle. Emotional and behavioral abnormalities are common presented with some neurological manifestations, e.g., tremor, asterixis, nystagmus, incoordination, urinary incontinence. Delirium is a behavioral disturbance and serious complication commonly found in consultation-liaison psychiatry. Its prevalence and incidence rates are varied, possibly depend on severity of illness, patient population, the method of assessment and the diagnostic criteria. Prevalence of delirium ranges from 10% to 30% and its incidence is between 3% and 29% for patients admitted in general hospitals (Siddiqi et al., 2006, Maneeton et al., 2007a, Praditsuwan et al., 2012). High prevalence and incidence are noted in elderly and severely ill patients. For instance, the prevalence of delirium in elderly and ICU patients are up to 40% and 80%, respectively (Bledowski and Trutia, 2012, Praditsuwan et al., 2012). An occurrence of delirium is associated with miserable clinical outcomes. It often increases morbidity, mortality, length of hospitalization, institutionalization, and poor functional outcome (Siddiqi et al., 2006, Cole et al., 2009, Fong et al., 2012). The mortality rate is higher in patients with hypoactive subtype of delirium (Yang et al., 2009). Delirium is often under recognized by health professionals. There are many faces for the clinical presentation of delirium. It can be caused by a variety of etiology. To prevent and minimize the consequences of delirium, physician should prompt intervenes for this condition (Attard et al., 2008).