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Delirium: The clinical concept

Published online by Cambridge University Press:  27 September 2006

A.D. (SANDY) MACLEOD
A.D. (SANDY) MACLEOD
Affiliation:
Nurse Maude Hospice and Brain Injury Rehabilitation Service, Burwood Hospital, Christchurch, New Zealand
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Abstract

Delirium is a common syndrome complicating terminal illness. It is underrecognized partly because it is a difficult clinical concept. Consciousness, awareness, alertness, arousal, awakeness, vigilance, and attention are some of the terms used to describe the deficits occurring in delirium. Though interconnected, they are often loosely defined. Alertness is the primary impairment, and attentional deficits are objective clinical indices of the cognitive impairments of delirium. Simple bedside assessments of delirium are considered. The “deliriant” threshold and the symptomatic fluctuations of delirium are important concepts in the understanding of delirium. Jackson's conceptualization of the nervous system is relevant to delirium. Raising the deliriant threshold by multicomponent interventions is the intent of the palliative management of terminal delirium.

Keywords

DeliriumConsciousnessAwarenessAttentionDeliriant threshold
Type
REVIEW ARTICLES
Information
Palliative & Supportive Care , Volume 4 , Issue 3 , September 2006 , pp. 305 - 312
Copyright
© 2006 Cambridge University Press

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References

REFERENCES

American Psychiatric Association (1994). Diagnostic and Statistical Manual of Mental Disorders, 4th ed. Washington, DC: American Psychiatric Association.
American Psychiatric Association (2000). Diagnostic and Statistical Manual of Mental Disorders, 4th ed., text revised. Washington, DC: American Psychiatric Association.
Baranowski, S.L. & Patten, S.B. (2000). The predictive value of dysgraphia and constructional apraxia for delirium in psychiatric patients. Canadian Journal of Psychiatry, 45, 75–78.Google Scholar
Bateman, D.E. (2000). Neurological assessment of coma. Journal of Neurology, Neurosurgery, and Psychiatry, 71, i13–i17.Google Scholar
Berrios, G.E. (1985). Positive and negative symptoms and Jackson. Archives of General Psychiatry, 42, 95–97.Google Scholar
Breitbart, W. & Sparrow, B. (1998). Management of delirium in the terminally ill. Progress in Palliative Care, 6, 107–113.Google Scholar
Britton, A. & Russell, R. (2000). Multidisciplinary team interventions for delirium in patients with chronic cognitive impairments. Cochrane Database Systems Review, 2, CD000395.Google Scholar
Brown, V.J. & Bowman, E.M. (2002). Alertness. In Encyclopedia of the Human Brain, Ramachandran, V.S. (ed.), pp. 99–110. San Diego, CA: Academic Press.
Burns, A., Gallagley, A., & Byrne, J. (2004). Delirium: A review. Journal of Neurology, Neurosurgery, and Psychiatry, 75, 362–367.Google Scholar
Dietrich, A. (2003). Functional neuroanatomy of altered states of consciousness: The transient hypofrontality hypothesis. Consciousness and Cognition, 12, 231–256.Google Scholar
Elie, M., Cole, M.G., Primeau, F.F., et al. (1998). Delirium risk factors in elderly hospitalized patients. Journal of General Internal Medicine, 13, 204–212.Google Scholar
Ey, H. (1962). Hughlings Jackson's principles and the organo-dynamic concept of psychiatry. American Journal of Psychiatry, 118, 663–682.Google Scholar
Fayers, P.M., Hjermstad, M.J., Ranhoff, A.H., et al. (2005). Which Mini-Mental State Exam items can be used to screen for delirium and cognitive impairment? Journal of Pain and Symptom Management, 30, 41–50.Google Scholar
Geschwind, N. (1982). Disorders of attention: A frontier in neuropsychology. Philosophical Transactions of the Royal Society of London, B, 298, 173–185.Google Scholar
Greiner, F.C. (1817). Der traum and des fieberhafte irreseyn. Altenburg: Brockhaus.
Inouye, S.K. (1998). Delirium in hospitalised older patients: Recognition and risk factors. Journal of Geriatric Psychiatry and Neurology, 11, 118–125.Google Scholar
Inouye, S.K. & Charpentier, P.A. (1996). Precipitating factors for delirium in hospitalized elderly persons. JAMA, 275, 852–857.Google Scholar
Inouye, S., van Dyck, C., Alessi, C., et al. (1990). Clarifying confusion: The Confusional Assessment Method. Annals of Internal Medicine, 113, 941–948.Google Scholar
James, W. (1890). The Principles of Psychology. Cambridge, MA: Harvard University Press.
Lawler, P.G., Gagnon, B., Mancini, I.L., et al. (2000). Occurrence, causes, and outcomes of delirium in patients with advanced cancer. Archives of Internal Medicine, 160, 786–794.Google Scholar
Leentjens, A.F.G. & van der Mast, R.C. (2005). Delirium in elderly people: An update. Current Opinions in Psychiatry, 18, 325–330.Google Scholar
Lindesay, J. (1999). The concept of delirium. Dementia and Geriatric Cognitive Disorders, 10, 310–314.Google Scholar
Lipowski, Z.J. (1980). Delirium. Springfield, IL: Charles C. Thomas.
Lipowski, Z.J. (1985). Delirium (Acute confusional state). In Handbook of Clinical Neurology: Neurobehavioral Disorders, vol. 2, Frederiks, J.A.M. (Ed.), pp. 523–559. Amsterdam: Elsevier.
Liptzin, B. (1999). What criteria should be used for the diagnosis of delirium? Dementia and Geriatric Cognitive Disorders, 10, 3.Google Scholar
Litaker, D., Locala, J., Franco, K., et al. (2001). Preoperative risk factors for postoperative delirium. General Hospital Psychiatry, 23, 84–89.Google Scholar
Mach, J.R., Jr., Kabat, V., Olson, D., et al. (1996). Delirium and right hemisphere dysfunction in cognitively impaired older persons. International Psychogeriatrics, 8, 378–381.Google Scholar
Macleod, A.D. & Whitehead, L.E. (1997). Dysgraphia and terminal delirium. Palliative Medicine, 11, 127–132.Google Scholar
Meagher, D.J. (2001). Delirium: Optimizing management. British Medical Journal, 322, 144–149.Google Scholar
Moruzzi, G. & Magoun, H.W. (1949). Brain stem reticular formation and the activation of the EEG. Electroencephalography and Clinical Neurophysiology, 1, 455–473.Google Scholar
Moscovitch, M. (1979). Information processing and the cerebral hemisheres. In Handbook of Behavioral Neurology. Neuropsychology, Gazzaniga, M.S. (ed.), vol. 2, pp. 379–466. New York: Plenum Publishing Corp.
Power, T.D. (1965). Some aspects of brain—mind relationship. British Journal of Psychiatry, 111, 1215–1223.Google Scholar
Rockwood, K. & Bhat, R. (2004). Should we think before we treat delirium? Internal Medicine Journal, 34, 76–78.Google Scholar
Rockwood, K., Cosway, S., Stolee, P., et al. (1994). Increasing the recognition of delirium in elderly patients. Journal of the American Geriatric Society, 42, 252–256.Google Scholar
Romano, J. & Engel, G.L. (1944). Delirium 1. Electroencephalographic data. Archives of Neurology and Psychiatry, 51, 356–377.Google Scholar
Ross, C.A. (1991). CNS arousal systems: Possible role in delirium. International Psychogeriatrics, 3, 353–371.Google Scholar
Sherrington, C. (1906). The Integrative Action of the Nervous System, pp. 156–157. New Haven: Yale University Press.
Stagno, D., Gibson, C., & Breitbart, W. (2004). The delirium subtypes: A review of prevalence, phenomenology, pathophysiology, and treatment response. Palliative & Support Care, 2, 171–179.Google Scholar
Stedeford, A. (1978). Understanding confusional states. British Journal of Hospital Medicine, 20, 694–704.Google Scholar
Trzepacz, P.T. (1999). Update on the neuropathogenesis of delirium. Dementia and Geriatric Cognitive Disorders, 10, 330–334.Google Scholar
Trzepacz, P.T. & Meagher, D.J. (2005). Delirium. In The American Psychiatric Publishing Textbook of Psychosomatic Medicine, Levenson, J.L. (ed.), pp. 91–125. Washington, DC: American Psychiatric Publishing.
Vecera, S.P. & Luck, S.J. (2002). Attention. In Encyclopedia of the Human Brain, Ramachandran, V.S. (ed.), pp. 269–284. San Diego, CA: Academic Press.
World Health Organization. (1992). The ICD 10 classification of mental and behavioral disorders. Diagnostic criteria for research. Geneva: World Health Organization.
Young, G.B. & Pigott, S.E. (1999). Neurobiological basis of consciousness. Archives of Neurology, 56, 153–157.Google Scholar
Zeman, A. (2001). Consciousness. Brain, 124, 1263–1289.Google Scholar
Zou, Y., Cole, M.G., Primeau, F.J., et al. (1998). Detection and diagnosis of delirium in the elderly: Psychiatrist diagnosis, confusion assessment method, or consensus diagnosis? International Psychogeriatrics, 10, 303–308.Google Scholar