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October 2, 1987, Vol 258, No. 13 >
ARTICLE | October 2, 1987

Delirium (Acute Confusional States) FREE

Z. J. Lipowski, MD, FRCP(C)
[+] Author Affiliations

Reprint requests to Clarke Institute of Psychiatry, 250 College St, Toronto, Ontario, Canada M5T 1R8 (Dr Lipowski).


JAMA. 1987;258(13):1789-1792. doi:10.1001/jama.1987.03400130103041
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References

Delirium (acute confusional states), a common and often overlooked psychiatric disorder, can occur at any age, but elderly persons are especially prone to develop it. In later life, it is often a conspicuous feature of systemic or cerebral disease and drug (notably anticholinergic) toxicity, and it may constitute a grave prognostic sign. Its development in a hospitalized patient may interfere with his or her management, disrupt ward routine, and cause medicolegal complications as a result of patient injury. Acute onset of a fluctuating level of awareness, accompanied by sleep-wake cycle disruption, lethargy or agitation, and nocturnal worsening of symptoms, are diagnostic. Early recognition of delirium and treatment of its underlying cause are essential.

(JAMA 1987;258:1789-1792)

REFERENCES

1 +
Aita JA:  Everyman's psychosis—the delirium . Nebr Med J 1968;;10:424-427.
2 +
Stead EA:  Reversible madness . Med Times 1966;;94:1403-1406.
3 +
Daniel DG:  Disguises of delirium . South Med J 1985;;78:666-672.
4 +
Perez EL, Silverman M:  Delirium: The often overlooked diagnosis . Int J Psychiatry Med 1984;; 14:181-189.
5 +
Trzepacz PT, Teague GB, Lipowski ZJ:  Delirium and other organic mental disorders in a general hospital . Gen Hosp Psychiatry 1985;;7:101-106.
6 +
Lipowski ZJ:  Transient cognitive disorders (delirium, acute confusional states) in the elderly . Am J Psychiatry 1983;;140:1426-1436.
7 +
Lipowski ZJ: Delirium: Acute Brain Failure in Man . Springfield, Ill, Charles C Thomas Publishers, 1980;.
8 +
Diagnostic and Statistical Manual of Mental Disorders , ed 3. Washington, DC, American Psychiatric Association, 1980;.
9 +
Gillick MR, Serrell NA, Gillick LS:  Adverse consequences of hospitalization in the elderly . Soc Sci Med 1982;;16:1033-1038.
10 +
Warshaw GA, Moore JT, Friedman SW, et al:  Functional disability in the hospitalized elderly . JAMA 1982;;248:847-850.
11 +
Utilization of Short-Stay Hospitals: Annual Summary for the United States, 1980 . US Dept of Health and Human Services National Center for Health Statistics, 1982;, series 13, No. (64) .
12 +
Hodkinson HM: Common Symptoms of Disease in the Elderly . Boston, Blackwell Scientific Publications Inc, 1976;.
13 +
Rabins PV, Folstein MF: Delirium and dementia:  Diagnostic criteria and fatality rates . Br J Psychiatry 1982;;140:149-153.
14 +
Weddington WW:  The mortality of delirium: An underappreciated problem? Psychosomatics 1982;;23:1232-1235.
15 +
Fogel BS, Mills MJ, Landen JE:  Legal aspects of the treatment of delirium . Hosp Community Psychiatry 1986;;37:154-158.
16 +
Lipowski ZJ:  Delirium (acute confusional state) , in Frederiks JAM (ed): Handbook of Clinical Neurology . Amsterdam, Elsevier Science Publishers, 1985;, vol 2 (No. (46) ): Neurobehavioural Disorders, pp 523-559.
17 +
Geschwind N:  Disorders of attention . Philos Trans R Soc Lond Biol 1982;;298:173-185.
18 +
Diagnostic and Statistical Manual of Mental Disorders , ed 3 revised. Washington, DC, American Psychiatric Association, 1987;.
19 +
Engel GL, Romano J:  Delirium: A syndrome of cerebral insufficiency . J Chronic Dis 1959;;9:260-277.
20 +
Adams F:  Neuropsychiatric evaluation and treatment of delirium in the critically ill cancer patient . Cancer Bull 1984;;36:156-160.
21 +
Massie MJ, Holland JC, Glass E:  Delirium in terminally ill cancer patients . Am J Psychiatry 1983;;140:1048-1050.
22 +
Lipowski ZJ:  Acute confusional states (delirium) in the elderly , in Albert ML (ed): Clinical Neurology of Old Age . New York, Oxford University Press Inc, 1984;, pp 277-297.
23 +
Blazer DG, Federspiel CF, Ray WA, et al:  The risk of anticholinergic toxicity in the elderly: A study of prescribing practices in two populations . J Gerontol 1983;;28:31-35.
24 +
Flint FJ, Richards SM:  Organic basis of confusional states in the elderly . Br Med J Clin Res 1956;; 2:1537-1539.
25 +
Hodkinson HM:  Mental impairment in the elderly . J R Coll Physicians Lond 1973;;7:305-317.
26 +
 Medication for the elderly . J R Coll Physicians Lond 1984;;18:7-17.
27 +
 Organic mental impairment in the elderly . J R Coll Physicians Lond 1981;;15:141-167.
28 +
 Senility reconsidered . JAMA 1980;;244:259-264.
29 +
Millar HR:  Psychiatric morbidity in elderly surgical patients . Br J Psychiatry 1981;;138:17-20.
30 +
Seymour DG, Pringle R:  Post-operative complications in the elderly surgical patient . Gerontology 1983;;29:262-270.
31 +
Williams MA, Campbell EB, Raynor SM, et al:  Reducing acute confusional states in elderly patients with hip fractures . Res Nurs Health 1985;;8: 329-337.
32 +
Blass JP, Plum F:  Metabolic encephalopathies in older adults , in Katzman R, Terry RD (eds): The Neurology of Aging . Philadelphia, FA Davis Co Publishers, 1983;, pp 189-220.
33 +
Itil T, Fink M:  Anticholinergic drug-induced delirium: Experimental modification, quantitative EEG and behavioral correlations . J Nerv Ment Dis 1966;;143:492-507.
34 +
Kral VA:  Confusional states: Description and management , in Howells JG (ed): Modern Perspectives in the Psychiatry of Old Age . New York, Brunner/Mazel Inc, 1975;, pp 356-362.
35 +
Jacobs S, Mason J, Kosten T, et al:  Urinary free cortisol excretion in relation to age in acutely stressed persons with depressive symptoms . Psychosom Med 1984;;46:213-221.
36 +
McIntosh TK, Bush HL, Yeston NS, et al:  Beta-endorphin, cortisol and postoperative delirium: A preliminary report . Psychoneuroendocrinology 1985;;10:303-313.
37 +
Anthony JC, LeResche L, Niaz U, et al:  Limits of the 'Mini-Mental State' as a screening test for dementia and delirium among hospital patients . Psychol Med 1982;;12:397-408.
38 +
Obrecht R, Okhomina FOA, Scott DF:  Value of EEG in acute confusional states . J Neurol Neurosurg Psychiatry 1979;;42:75-77.
39 +
Pro JD, Wells CE:  The use of the electroencephalogram in the diagnosis of delirium . Dis Nerv Syst 1977;;38:804-808.
40 +
Brenner RP:  The electroencephalogram in altered states of consciousness . Neurol Clinics 1985;;3:615-631.
41 +
Steinhart MJ:  The use of haloperidol in geriatric patients with organic mental disorder . Curr Ther Res 1983;;33:132-143.
42 +
Rosenbloom AJ:  Optimizing drug treatment of alcohol withdrawal . Am J Med 1986;;81:901-904.
43 +
Johnson AL, Hollister LE, Berger PA:  The anticholinergic intoxication syndrome: Diagnosis and treatment . J Clin Psychiatry 1981;;42:313-317.
44 +
Nilsson E:  Physostigmine treatment in various drug-induced intoxications . Ann Clin Res 1982;;14: 165-172.
45 +
Misra P:  Hepatic encephalopathy . Med Clin North Am 1981;;65:209-226.

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Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature

Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal

1 +
Aita JA:  Everyman's psychosis—the delirium . Nebr Med J 1968;;10:424-427.
2 +
Stead EA:  Reversible madness . Med Times 1966;;94:1403-1406.
3 +
Daniel DG:  Disguises of delirium . South Med J 1985;;78:666-672.
4 +
Perez EL, Silverman M:  Delirium: The often overlooked diagnosis . Int J Psychiatry Med 1984;; 14:181-189.
5 +
Trzepacz PT, Teague GB, Lipowski ZJ:  Delirium and other organic mental disorders in a general hospital . Gen Hosp Psychiatry 1985;;7:101-106.
6 +
Lipowski ZJ:  Transient cognitive disorders (delirium, acute confusional states) in the elderly . Am J Psychiatry 1983;;140:1426-1436.
7 +
Lipowski ZJ: Delirium: Acute Brain Failure in Man . Springfield, Ill, Charles C Thomas Publishers, 1980;.
8 +
Diagnostic and Statistical Manual of Mental Disorders , ed 3. Washington, DC, American Psychiatric Association, 1980;.
9 +
Gillick MR, Serrell NA, Gillick LS:  Adverse consequences of hospitalization in the elderly . Soc Sci Med 1982;;16:1033-1038.
10 +
Warshaw GA, Moore JT, Friedman SW, et al:  Functional disability in the hospitalized elderly . JAMA 1982;;248:847-850.
11 +
Utilization of Short-Stay Hospitals: Annual Summary for the United States, 1980 . US Dept of Health and Human Services National Center for Health Statistics, 1982;, series 13, No. (64) .
12 +
Hodkinson HM: Common Symptoms of Disease in the Elderly . Boston, Blackwell Scientific Publications Inc, 1976;.
13 +
Rabins PV, Folstein MF: Delirium and dementia:  Diagnostic criteria and fatality rates . Br J Psychiatry 1982;;140:149-153.
14 +
Weddington WW:  The mortality of delirium: An underappreciated problem? Psychosomatics 1982;;23:1232-1235.
15 +
Fogel BS, Mills MJ, Landen JE:  Legal aspects of the treatment of delirium . Hosp Community Psychiatry 1986;;37:154-158.
16 +
Lipowski ZJ:  Delirium (acute confusional state) , in Frederiks JAM (ed): Handbook of Clinical Neurology . Amsterdam, Elsevier Science Publishers, 1985;, vol 2 (No. (46) ): Neurobehavioural Disorders, pp 523-559.
17 +
Geschwind N:  Disorders of attention . Philos Trans R Soc Lond Biol 1982;;298:173-185.
18 +
Diagnostic and Statistical Manual of Mental Disorders , ed 3 revised. Washington, DC, American Psychiatric Association, 1987;.
19 +
Engel GL, Romano J:  Delirium: A syndrome of cerebral insufficiency . J Chronic Dis 1959;;9:260-277.
20 +
Adams F:  Neuropsychiatric evaluation and treatment of delirium in the critically ill cancer patient . Cancer Bull 1984;;36:156-160.
21 +
Massie MJ, Holland JC, Glass E:  Delirium in terminally ill cancer patients . Am J Psychiatry 1983;;140:1048-1050.
22 +
Lipowski ZJ:  Acute confusional states (delirium) in the elderly , in Albert ML (ed): Clinical Neurology of Old Age . New York, Oxford University Press Inc, 1984;, pp 277-297.
23 +
Blazer DG, Federspiel CF, Ray WA, et al:  The risk of anticholinergic toxicity in the elderly: A study of prescribing practices in two populations . J Gerontol 1983;;28:31-35.
24 +
Flint FJ, Richards SM:  Organic basis of confusional states in the elderly . Br Med J Clin Res 1956;; 2:1537-1539.
25 +
Hodkinson HM:  Mental impairment in the elderly . J R Coll Physicians Lond 1973;;7:305-317.
26 +
 Medication for the elderly . J R Coll Physicians Lond 1984;;18:7-17.
27 +
 Organic mental impairment in the elderly . J R Coll Physicians Lond 1981;;15:141-167.
28 +
 Senility reconsidered . JAMA 1980;;244:259-264.
29 +
Millar HR:  Psychiatric morbidity in elderly surgical patients . Br J Psychiatry 1981;;138:17-20.
30 +
Seymour DG, Pringle R:  Post-operative complications in the elderly surgical patient . Gerontology 1983;;29:262-270.
31 +
Williams MA, Campbell EB, Raynor SM, et al:  Reducing acute confusional states in elderly patients with hip fractures . Res Nurs Health 1985;;8: 329-337.
32 +
Blass JP, Plum F:  Metabolic encephalopathies in older adults , in Katzman R, Terry RD (eds): The Neurology of Aging . Philadelphia, FA Davis Co Publishers, 1983;, pp 189-220.
33 +
Itil T, Fink M:  Anticholinergic drug-induced delirium: Experimental modification, quantitative EEG and behavioral correlations . J Nerv Ment Dis 1966;;143:492-507.
34 +
Kral VA:  Confusional states: Description and management , in Howells JG (ed): Modern Perspectives in the Psychiatry of Old Age . New York, Brunner/Mazel Inc, 1975;, pp 356-362.
35 +
Jacobs S, Mason J, Kosten T, et al:  Urinary free cortisol excretion in relation to age in acutely stressed persons with depressive symptoms . Psychosom Med 1984;;46:213-221.
36 +
McIntosh TK, Bush HL, Yeston NS, et al:  Beta-endorphin, cortisol and postoperative delirium: A preliminary report . Psychoneuroendocrinology 1985;;10:303-313.
37 +
Anthony JC, LeResche L, Niaz U, et al:  Limits of the 'Mini-Mental State' as a screening test for dementia and delirium among hospital patients . Psychol Med 1982;;12:397-408.
38 +
Obrecht R, Okhomina FOA, Scott DF:  Value of EEG in acute confusional states . J Neurol Neurosurg Psychiatry 1979;;42:75-77.
39 +
Pro JD, Wells CE:  The use of the electroencephalogram in the diagnosis of delirium . Dis Nerv Syst 1977;;38:804-808.
40 +
Brenner RP:  The electroencephalogram in altered states of consciousness . Neurol Clinics 1985;;3:615-631.
41 +
Steinhart MJ:  The use of haloperidol in geriatric patients with organic mental disorder . Curr Ther Res 1983;;33:132-143.
42 +
Rosenbloom AJ:  Optimizing drug treatment of alcohol withdrawal . Am J Med 1986;;81:901-904.
43 +
Johnson AL, Hollister LE, Berger PA:  The anticholinergic intoxication syndrome: Diagnosis and treatment . J Clin Psychiatry 1981;;42:313-317.
44 +
Nilsson E:  Physostigmine treatment in various drug-induced intoxications . Ann Clin Res 1982;;14: 165-172.
45 +
Misra P:  Hepatic encephalopathy . Med Clin North Am 1981;;65:209-226.

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