We're unable to sign you in at this time. Please try again in a few minutes.
We were able to sign you in, but your subscription(s) could not be found. Please try again in a few minutes.
There may be a problem with your account. Please contact the AMA Service Center to resolve this issue.
Contact the AMA Service Center:
Telephone: 1 (800) 262-2350 or 1 (312) 670-7827  *   Email: subscriptions@jamanetwork.com
Error Message ......
JAMA Patient Page |

Delirium FREE

Janet M. Torpy, MD, Writer; Alison E. Burke, MA, Illustrator; Richard M. Glass, MD, Editor
JAMA. 2010;304(7):814. doi:10.1001/jama.304.7.814.
Text Size: A A A
Published online

Delirium is a disturbance of consciousness (awareness of the person's environment) characterized by altered or shifting mental status and inattention (reduced ability to focus, sustain, or shift attention). There are also changes in cognition (basic mental functions) such as memory impairment, disorientation to time or place, and language disturbance. There also may be disturbances of perception (accurate appreciation of the environment) such as hallucinations (seeing or hearing things that are not actually there), abnormal speech, abnormal movements (including tremors or picking at clothing), disruptive or violent behavior, and sudden shifts in emotions. To qualify for a diagnosis of delirium, the signs and symptoms must have a short onset (over a period of hours or days) and change over the course of the day. It is important to make a clear distinction between delirium and dementia (such as Alzheimer disease). Dementia is a disturbance in intellectual (thinking) functions and memory that is usually gradually progressive over a long period.

Having delirium along with another medical illness can significantly increase a person's chance of dying of that illness. It is important for doctors to identify delirium so that it can be treated to improve the person's overall prognosis.

The August 18, 2010, issue of JAMA includes an article about diagnosing delirium. This Patient Page is based on one previously published in the December 24/31, 2008, issue of JAMA.


  • New or worsening medical illnesses such as severe infections or heart failure

  • Medications, abused drugs, or poisons

  • Drug withdrawal syndromes, such as delirium tremens (delirium from alcohol withdrawal)

  • Psychiatric (mental) illnesses

  • Severe pain, immobilization, or sleep deprivation


  • Identifying and treating the underlying cause of delirium is essential.

  • Supportive care, including mechanical ventilation and life-support medications, may be necessary.

  • The effects of and need for all medications the patient is receiving should be assessed.

  • Replacement of vitamin B should be considered for persons with alcoholism or who are malnourished.

  • Antipsychotic medications may be used to reduce the symptoms of delirium.

  • Benzodiazepines (antianxiety medications) may be used, particularly in cases of drug withdrawal syndromes.

  • If no other treatments are effective and the patient is at clear risk of harm to self or others, soft restraints may be needed for a short time.

  • Psychiatric assessment and management are important, particularly in cases of delirium not easily explainable by poison exposure, medication effects, or medical illness.



To find this and previous JAMA Patient Pages, go to the Patient Page link on JAMA's Web site at http://www.jama.com. Many are available in English and Spanish. A Patient Page on dementia was published in the November 19, 2008, issue and one on psychiatric illness in older adults was published in the June 7, 2000, issue.

Sources: American Psychiatric Association, National Institute of Mental Health, American Geriatrics Society, National Institute on Aging

The JAMA Patient Page is a public service of JAMA. The information and recommendations appearing on this page are appropriate in most instances, but they are not a substitute for medical diagnosis. For specific information concerning your personal medical condition, JAMA suggests that you consult your physician. This page may be photocopied noncommercially by physicians and other health care professionals to share with patients. To purchase bulk reprints, call 312/464-0776.





Also Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
Please click the checkbox indicating that you have read the full article in order to submit your answers.
Your answers have been saved for later.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.


Spanish Patient Pages
Supplemental Content

Some tools below are only available to our subscribers or users with an online account.

0 Citations

Related Content

Customize your page view by dragging & repositioning the boxes below.

Articles Related By Topic
Related Collections
PubMed Articles

Care at the Close of Life: Evidence and Experience
Agitation and Delirium at the End of Life: "We Couldn't Manage Him"

Care at the Close of Life: Evidence and Experience
Delirium, Cognitive Dysfunction, and Fatigue