Motor subtypes of delirium: Past, present and future

Abstract

Clinical subtyping of delirium according to motor-activity profile has considerable potential to account for the heterogeneity of this complex and multifactorial syndrome. Previous work has identified a range of clinically important differences between motor subtypes in relation to detection, causation, treatment experience and prognosis, but studies have been hampered by inconsistent methodology, especially in relation to definition of subtypes. This article considers research to date, including a number of recent studies that have attempted to address these issues and identify a means of achieving greater consistency in approaches to subtyping. Possibilities for future work are discussed and a research plan for the field is outlined.

Clarifying Delirium Management: Practical, Evidenced-Based, Expert Recommendations for Clinical Practice

“…There is no clear consensus or evidence. 130 One approach is to avoid pharmacological intervention, as medications are often the cause of or can worsen delirium. However when perceptual disturbances or delusions are perceived to be present with a hypoactive delirium, the use of antipsychotic medications targeted at these symptoms may be warranted.…”

Are Melatonin and its Agonist the Natural Solution for Prevention of Delirium in Critically Ill Patients? A Review of Current Studies

“…Delirium could be classified to 3 subtypes, including hyperactive, hypoactive, and mixed-type, based on the systematic clinical observation of hospitalized patients (32)(33)(34). In non-ICU patients, hyperactive delirium is recognized, while it is not observed in older patients (33,35).…”

“…In non-ICU patients, hyperactive delirium is recognized, while it is not observed in older patients (33,35). In ICU patients, the most common types of delirium are mixed and hypoactive.…”

“…In ICU patients, the most common types of delirium are mixed and hypoactive. Furthermore, hypoactive delirium is the major delirium witnessed in older patients (32,33,35). Melatonin degrades in the liver, and the metabolite of melatonin, 6-sulfatoxymelatonin (6-SMT), which is secreted in the kidney and could be directly measured (7).…”

Hearing the Child's Voice: Their Lived Experience in the Pediatric Intensive Care Unit

“…ICU delirium, also known as ICU psychosis, acute confusion, and ICU syndrome (Meagher, 2009;Morandi, Jackson, & Ely, 2009), is characterized by diffuse cognitive dysfunction, perceptual disturbances, altered sleep-wake cycles, disturbances in thought and language, and altered mood and affect. Symptom onset is usually acute with intensity of symptoms fluctuating with delirium duration (Turkel & Tavare, 2003).…”