Delirium is sudden severe confusion due to rapid changes in brain function that occur with physical or mental illness.
Acute confusional state; Acute brain syndrome
Delirium is most often caused by physical or mental illness, and is usually temporary and reversible. Many disorders cause delirium. Often, the conditions are ones that do not allow the brain to get oxygen or other substances.
Delirium involves a quick change between mental states (for example, from lethargy to agitation and back to lethargy).
The following tests may have abnormal results:
The following tests may also be done:
The goal of treatment is to control or reverse the cause of the symptoms. Treatment depends on the condition causing delirium. The person may need to stay in the hospital for a short time.
Stopping or changing medications that worsen confusion, or that are not necessary, may improve mental function. After asking about your medical history, your doctor will discuss medicines and substances that can worsen confusion, such as alcohol.
Disorders that contribute to confusion should be treated. These may include:
Treating medical and mental disorders often greatly improves mental function.
Medicines may be needed to control aggressive or agitated behaviors. These are usually started at very low dosages and adjusted as needed.
Some people with delirium may benefit from hearing aids, glasses, or cataract surgery.
Other treatments that may be helpful:
Acute conditions that cause delirium may occur with chronic disorders that cause dementia. Acute brain syndromes may be reversible by treating the cause.
Delirium often lasts about 1 week. It may take several weeks for mental function to return to normal . Full recovery is common, but depends on the underlying cause of the delirium.
Call your health care provider if there is a rapid change in mental status.
Treating the conditions that cause delirium can reduce its risk. In hospitalized patients, avoiding sedatives, prompt treatment of metabolic disorders and infections, and using reality orientation programs will reduce the risk of delirium in those at high risk.
Mendez MF, Kremen SA. Delirium. In: Daroff RB, Fenichel GM, Jankovic J, Mazziotta JC, eds. Bradley's Neurology in Clinical Practice. 6th ed. Philadelphia, Pa: Elsevier Saunders; 2012:chap 4.
Smith JP, Seirafi J. Delirium and dementia. In: Marx JA, Hockberger RS, Walls RM, et al., eds. Rosen's Emergency Medicine: Concepts and Clinical Practice. 8th ed. Philadelphia, Pa: Elsevier Mosby; 2013:chap 104.