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Case 25 - “I Want to Go Home”

Delirium

Published online by Cambridge University Press:  31 October 2024

Matthew Gibfried
Affiliation:
Saint Louis University School of Medicine, Missouri
George T. Grossberg
Affiliation:
Saint Louis University School of Medicine, Missouri
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Summary

Delirium as a complex neuropsychiatric syndrome characterized by disturbances in attention, awareness, and cognition that are not explained by a pre-existing neurocognitive disorder. The causes of delirium are varied. The most common causes of delirium in the long-term care setting are likely urinary tract infections, untreated pain, and medication side effects. The initial steps recommended in managing delirium involve identifying and addressing underlying medical conditions, reducing environmental triggers, and minimizing exposure to drugs. Besides treatment of the cause, management of delirium primarily involves psychosocial interventions. These can include environmental modifications such as addressing poor lighting, excessive noise, or lack of orientation cues.

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Chapter
Information
Clinical Case Studies in Long-Term Care Psychiatry
Navigating Common Mental Health Challenges in Geriatric Care
, pp. 121 - 125
Publisher: Cambridge University Press
Print publication year: 2024

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References

References

American Psychiatric Association. (2022). Diagnostic and Statistical Manual of Mental Disorders. 5th ed. text rev. (American Psychiatric Association.)Google Scholar
Inouye, S. K., Westendorp, R. G., & Saczynski, J. S. (2014). Delirium in elderly people. The Lancet, 383 (9920), 911922.CrossRefGoogle ScholarPubMed
Ormseth, C. H., LaHue, S. C., Oldham, M. A., Josephson, S. A., Whitaker, E., & Douglas, V. C. (2023). Predisposing and precipitating factors associated with delirium: A systematic review. JAMA Network Open, 6 (1), e2249950. https://doi.org/10.1001/jamanetworkopen.2022.49950CrossRefGoogle ScholarPubMed
Wilson, J. E., Mart, M. F., Cunningham, C., Shehabi, Y., Girard, T. D., MacLullich, A. M. J., Slooter, A. J. C., & Ely, E. W. (2020). Delirium. Nature Reviews. Disease primers, 6 (1), 90. www.nature.com/articles/s41572-020-00223-4CrossRefGoogle ScholarPubMed
Green, J. R., Smith, J., Teale, E., Collinson, M., Avidan, M. S., Schmitt, E. M., Inouye, S. K., & Young, J. (2019). Use of the confusion assessment method in multicentre delirium trials: Training and standardization. BMC Geriatrics, 19 (1), 107. doi: 10.1186/s12877-019-1129-8. PMID: 30991945; PMCID: PMC6466721.CrossRefGoogle Scholar
Burry, L., Mehta, S., Perreault, M. M., Luxenberg, J. S., Siddiqi, N., Hutton, B., Fergusson, D. A., Bell, C., & Rose, L. (2018). Antipsychotics for treatment of delirium in hospitalized non-ICU patients. Cochrane Database of Systematic Reviews, 6 (6): CD005594. doi: 10.1002/14651858.CD005594.pub3. PMID: 29920656; PMCID: PMC6513380.Google Scholar
Sheikh, A. B., Javed, N., Leyba, K., Khair, A. H., Ijaz, Z., Dar, A. A., Hanif, H., Farooq, A., & Shekhar, R. (2021). Pet-assisted therapy for delirium and agitation in hospitalized patients with neurocognitive impairment: A review of literature. Geriatrics (Basel), 6 (4), 96. doi: 10.3390/geriatrics6040096. PMID: 34698207; PMCID: PMC8544463.CrossRefGoogle ScholarPubMed

Further Reading

Desai, A., & Grossberg, G. (2017). Psychiatric Consultation in Long-Term Care. A Guide for Healthcare Professionals. 2nd ed. (Cambridge University Press.) pp. 102119.CrossRefGoogle Scholar
Fong, T. G., & Inouye, S. K. (2022). The inter-relationship between delirium and dementia: The importance of delirium prevention. Nature Reviews. Neurology, 18 (10), 579596. www.nature.com/articles/s41582-022-00698-7CrossRefGoogle ScholarPubMed
Gross, A. L., Tommet, D., D’Aquila, M., Schmitt, E., Marcantonio, E. R., Helfand, B., Inouye, S. K., Jones, R. N., & BASIL Study Group (2018). Harmonization of delirium severity instruments: A comparison of the DRS-R-98, MDAS, and CAM-S using item response theory. BMC Medical Research Methodology, 18 (1), 92. www.ncbi.nlm.nih.gov/pmc/articles/PMC6131747/CrossRefGoogle ScholarPubMed
Woodhouse, R., Burton, J. K., Rana, N., Pang, Y. L., Lister, J. E., & Siddiqi, N. (2019). Interventions for preventing delirium in older people in institutional long-term care. The Cochrane Database of Systematic Reviews, 4 (4), CD009537. https://doi.org/10.1002/14651858.CD009537.pub3Google ScholarPubMed

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  • “I Want to Go Home”
  • Matthew Gibfried, Saint Louis University School of Medicine, Missouri, George T. Grossberg, Saint Louis University School of Medicine, Missouri
  • Book: Clinical Case Studies in Long-Term Care Psychiatry
  • Online publication: 31 October 2024
  • Chapter DOI: https://doi.org/10.1017/9781108630344.026
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  • “I Want to Go Home”
  • Matthew Gibfried, Saint Louis University School of Medicine, Missouri, George T. Grossberg, Saint Louis University School of Medicine, Missouri
  • Book: Clinical Case Studies in Long-Term Care Psychiatry
  • Online publication: 31 October 2024
  • Chapter DOI: https://doi.org/10.1017/9781108630344.026
Available formats
×

Save book to Google Drive

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Google Drive.

  • “I Want to Go Home”
  • Matthew Gibfried, Saint Louis University School of Medicine, Missouri, George T. Grossberg, Saint Louis University School of Medicine, Missouri
  • Book: Clinical Case Studies in Long-Term Care Psychiatry
  • Online publication: 31 October 2024
  • Chapter DOI: https://doi.org/10.1017/9781108630344.026
Available formats
×