Unravelling the pathophysiology of delirium: A focus on the role of aberrant stress responses

MacLullich, Alasdair M.J.; Ferguson, Karen; Miller, Thomas D.; Rooij, Sophia E. J. A. de; Cunningham, Colm

doi:10.1016/j.jpsychores.2008.05.019

Cited by 352 publications

(313 citation statements)

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“…It means that if by any mean psychiatric patient reach to delirious state the psychiatric symptoms may be subsided. Delirium is a common and serious acute neuropsychiatric syndrome with core features of inattention and cognitive impairment, and associated features including changes in arousal, altered sleep-wake cycle, and other changes in mental status [21]. Hypotheses about the pathophysiology of delirium are speculative and largely based on animal research.…”

Section: Discussionmentioning

confidence: 99%

Whether Delirium Acts as ECT?

Tripathi¹

2013

Aging Sci

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Delirium is defined by the acute onset of fluctuating cognitive impairment and a disturbance of consciousness with reduced ability to attend. It may occur at any age but is more common in older adults. By virtue of working in the psychogeriatric hospital (Department of Geriatric Mental Health, King George's Medical University, Lucknow, India), authors experienced that many elderly patients with psychiatric illness develops delirium because of various reasons. Subsequently, we observed that psychiatric manifestations of the patients improved significantly following recovery from delirium. A series of such four cases (case 1-Depression with psychotic features, 2-Manic episode, 3-Bipolar affective disorder current episode mania and 4-Depressive episode) later developed delirium has been presented and discussed in this paper. ICD-10 criteria were used for the diagnosis of delirium and psychiatric illnesses. Average stay of these patients in the hospital was 10 days. We found that signs and symptoms of these psychiatric disorders disappeared almost completely following the recovery from delirium. Therefore, it can be assumed that delirium potentially acts similar to ECT. By reporting such case we open a new dimension of research for effective treatment of the psychiatric patients. Inducing delirium in a patient is unethical but understanding pathophysiology behind it will certainly open the door for better cure of the ailing psychiatric patients.

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Section: Discussionmentioning

confidence: 99%

Whether Delirium Acts as ECT?

Tripathi¹

2013

Aging Sci

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“…Despite improved diagnosis and multiple potential treatments, the pathophysiological mechanisms of delirium remain unclear [57,58]. Hypotheses generated outside the ICU posit that delirium results from a decrease in acetylcholine and increase in dopamine [59,60].…”

Section: Definition Risk Factors and Monitoring For Deliriummentioning

confidence: 99%

“…Hypotheses generated outside the ICU posit that delirium results from a decrease in acetylcholine and increase in dopamine [59,60]. Other hypotheses include hypoxia, neurotransmitter imbalance [61], inflammation (related to the systemic inflammatory response syndrome or sepsis), aberrant stress responses [58], and toxic or metabolic derangements resulting in encephalopathy.…”

Section: Definition Risk Factors and Monitoring For Deliriummentioning

confidence: 99%

Pharmacological and Nonpharmacological Management of Delirium in Critically Ill Patients

2012

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Delirium is a common yet under-diagnosed syndrome of acute brain dysfunction, which is characterized by inattention, fluctuating mental status, altered level of consciousness, or disorganized thinking. Although our recognition of risk factors for delirium has progressed, our understanding of the underlying pathophysiologic mechanisms remains limited. Improvements in monitoring and assessment for delirium (particularly in the intensive care setting) have resulted in validated and reliable tools such as arousal scales and bedside delirium monitoring instruments. Once delirium is recognized and the modifiable risk factors are addressed, the next step in management (if delirium persists) is often pharmacological intervention. The sedatives, analgesics, and hypnotics most often used in the intensive care unit (ICU) to achieve patient comfort are all too frequently deliriogenic, resulting in a longer duration of ICU and hospital stay, and increased costs. Therefore, identification of safe and efficacious agents to reduce the incidence, duration, and severity of ICU delirium is a hot topic in critical care. Recognizing that there are no medications approved by the Food and Drug Administration (FDA) for the prevention or treatment of delirium, we chose anti-psychotics and alpha-2 agonists as the general pharmacological focus of this article because both were subjects of relatively recent data and ongoing clinical trials. Emerging pharmacological strategies for addressing delirium must be combined with nonpharmacological approaches (such as daily spontaneous awakening trials and spontaneous breathing trials) and early mobility (combined with the increasingly popular approach called: Awakening and Breathing Coordination, Delirium Monitoring, Early Mobility, and Exercise [ABCDE] of critical care) to develop evidence-based approaches that will ensure safer and faster recovery of the sickest patients in our healthcare system.

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“…Both the geriatric and pediatric populations are at risk of developing delirium (Dulcan, 2010). The elderly are www.intechopen.com more vulnerable to delirium because of the age-related loss of cholinergic reserve that is necessary for memory, learning, attention, and wakefulness (Maclullich et al, 2008).…”

Section: Agementioning

confidence: 99%