An Empirical Study of Delirium Subtypes

Liptzin, Benjamin; Levkoff, Sue E.

doi:10.1192/bjp.161.6.843

Cited by 355 publications

(252 citation statements)

References 7 publications

Supporting

Mentioning

233

Contrasting

Unclassified

Order By: Relevance

“…22 Agitated delirium: based on psychomotor classification of delirium, this refers to a hyperalert episode of delirium in which features of hyperactivity (motor restlessness) are evident. 23 Terminal delirium: this refers to an episode of delirium that occurs in the dying phase and thus implies that reversal will not be pursued. • What are the most appropriate tools for the diagnosis of delirium, including hypoactive subtype, in the dying phase?…”

Section: Goals Of Carementioning

confidence: 99%

End-of-Life Delirium: Issues Regarding Recognition, Optimal Management, and the Role of Sedation in the Dying Phase

Bush

Leonard

Agar

et al. 2014

Journal of Pain and Symptom Management

View full text Add to dashboard Cite

Context. In end-of-life care, delirium is often not recognized and poses unique management challenges, especially in the case of refractory delirium in the terminal phase.Objectives. To review: delirium in the terminal phase context, specifically in relation to recognition issues; the decision-making processes and management strategies regarding its reversibility; the potential refractoriness of delirium to symptomatic treatment; and the role of sedation in refractory delirium. Methods.We combined multidisciplinary input from delirium researchers and knowledge users at an international delirium study planning meeting and relevant electronic database literature searches (Ovid Medline, Embase, PsycINFO and CINAHL) to inform this narrative review.Results. The overall management strategy for delirium at the end of life is directed by the patient's prognosis in association with the patient's goals of care. As symptoms of delirium are often refractory in the terminal phase, especially in the case of agitated delirium, the judicious use of palliative sedation is frequently required. However, there remains a lack of high level evidence for the management of delirium in the terminal phase, including the role of antipsychotics and optimal sedation strategies. For the family and health care staff, clear communication, education and emotional support are vital components to assist with decision making and direct the treatment care plan. Conclusion.Further research on the effectiveness of delirium management strategies in the terminal phase for patients and their families is required. Further validation of assessment tools for diagnostic screening and severity measurement are needed in this patient population.

show abstract

Section: Goals Of Carementioning

confidence: 99%

End-of-Life Delirium: Issues Regarding Recognition, Optimal Management, and the Role of Sedation in the Dying Phase

Bush

Leonard

Agar

et al. 2014

Journal of Pain and Symptom Management

View full text Add to dashboard Cite

show abstract

“…2 '' While many clinicians associate delirium with hyperactive behaviour (e.g., restlessness, pulling out lines, striking out), hypoactive and mixed motor subtypes are also described. 5 Hypoactive delirium characterized by ''…decreased alertness, sparse or slow speech, lethargy, slow movements, staring, and apathy'' 5 may be present in over 40% of delirious older patients. 6 One must distinguish delirium from other cognitive disorders, 7 such as dementia, postoperative cognitive dysfunction (POCD), and emergence delirium.…”

Section: Definitionmentioning

confidence: 99%

“…2 » Alors que de nombreux cliniciens associent le delirium à un comportement hyperactif (par exemple, agitation, arrachage des perfusions, coups), des sous-types hypoactifs ou à motricité mixte ont également été décrits. 5 Un delirium hypoactif, caractérisé par « …une baisse de la vigilance, un discours ralenti ou rare, une léthargie, des mouvements lents, un regard fixe et de l'apathie » 5 peut être présent chez plus de 40 % des patients âgés délirants. 6 Il faut distinguer le delirium des autres troubles cognitifs, 7 tels que la démence, les troubles cognitifs dysfonctionnels postopératoires et le delirium à l'émergence de l'anesthésie.…”

Section: Définitionunclassified

Postoperative delirium: risk factors and management: Continuing Professional Development

Chaput

Bryson

2012

Can J Anesth/J Can Anesth

View full text Add to dashboard Cite

Purpose Postoperative delirium often remains undiagnosed and therefore untreated. The purpose of this continuing professional development module is to identify patients at high risk of developing delirium following noncardiac surgery and to provide tools to aid in the diagnosis of delirium at the bedside. Optimal prevention and treatment strategies are recommended. Principal findings Delirium is characterized by an acute onset and a fluctuating course, inattention, disorganized thinking and an altered level of consciousness, and occurs in up to 40% of patients in the perioperative period. The pathophysiology of delirium is multifactorial, but it is believed to be related to inflammation, altered neurotransmission, and stress in the patient who has had surgery. Acetylcholine and dopamine appear to play a significant role. There is an increased risk of a poor outcome in patients who develop delirium, including a longer hospital stay and death. Surgical and patient factors play a significant role in predicting who will subsequently develop delirium. Prevention is much more effective than treatment in the management of delirium. The most effective prevention strategies include proactive geriatric assessment and care of the patient on a geriatrics surgical ward as well as prophylactic low-dose antipsychotic agents. From an anesthetic perspective, evidence in some surgical populations would support the use of regional techniques and minimal sedation. If delirium develops, treatment with lowdose oral antipsychotics appears to be most effective.Conclusions Delirium is a serious condition that must be recognized early and treated promptly to minimize deleterious outcomes. In order to institute prevention strategies and treat the condition effectively when it occurs, the anesthesiologist must be vigilant in identifying patients at risk and in screening for this condition. Objectives of this Continuing Professional Development (CPD) module:After reading this module, the reader should be able to:1. Define delirium in the context of other cognitive changes following non-cardiac surgery. 2. Understand the incidence and adverse outcomes associated with delirium. 3. List predisposing and precipitating factors of postoperative delirium and identify the patient at risk. 4. Explain the underlying pathophysiologic mechanisms believed to be implicated in causing delirium. 5. Formulate an anesthetic plan that minimizes the risk of developing postoperative delirium. 6. Devise a management plan to treat postoperative delirium most effectively while minimizing the adverse effects of treatment.Like other Western nations, Canada's population is aging rapidly. Over the past 50 years, the proportion of Canadians over the age of 65 has risen from 7.7% to 13.7%. A Statistics Canada estimates that the proportion of seniors will double 123Can J Anesth/J Can Anesth (2012) 59:304-320 DOI 10.1007 yet again by 2036 and will represent 23-25% of Canada's population. B This rapid demographic shift will impact anesthesiologists and hospitals ...

show abstract

“…The mixed type of delirium represents a combination of criteria for both types. 15 It can be assumed that each delirium subtype has a special etiology and, therefore, a unique set of risk factors. 16 Although patients with encephalopathy usually have hypoactive delirium, pharmacologically-induced delirium typically is hyperactive.…”

Section: Elirium Is a Common And Significant Problem Because Itmentioning

confidence: 99%

Hypoactive Delirium After Cardiac Surgery as an Independent Risk Factor for Prolonged Mechanical Ventilation

Stransky

Schmidt

Ganslmeier

et al. 2011

Journal of Cardiothoracic and Vascular Anesthesia

111

View full text Add to dashboard Cite

An Empirical Study of Delirium Subtypes

Cited by 355 publications

References 7 publications

End-of-Life Delirium: Issues Regarding Recognition, Optimal Management, and the Role of Sedation in the Dying Phase

End-of-Life Delirium: Issues Regarding Recognition, Optimal Management, and the Role of Sedation in the Dying Phase

Postoperative delirium: risk factors and management: Continuing Professional Development

Hypoactive Delirium After Cardiac Surgery as an Independent Risk Factor for Prolonged Mechanical Ventilation

Contact Info

Product

Resources

About