3.9.13 Delirium

3.9.13 Delirium

Delirium

Delirium is a complex and severe neuropsychiatric syndrome characterized by acute changes in consciousness, cognition, and perception. It is a medical emergency that can occur as a result of a variety of underlying medical, surgical, or psychiatric conditions. Delirium is associated with significant morbidity and mortality, and the underlying neurobiology is not well understood.

The integrated neurobiology of delirium involves the interaction of several key brain systems, including the basal ganglia, thalamus, cortex, and limbic system. Abnormalities in these systems can result in disruptions in consciousness, cognition, and perception.

The basal ganglia and thalamus play a critical role in regulating attention, arousal, and cognition. Disruptions in the function of these structures can result in confusion, disorientation, and other cognitive disturbances.

The cortex is responsible for higher-level cognitive functions such as memory, attention, and perception. In delirium, the cortex is often impacted by a variety of factors, including reduced blood flow, oxidative stress, and inflammation. These disruptions can result in changes in perception, disordered thinking, and altered consciousness.

The limbic system is involved in the regulation of emotion, motivation, and reward. Abnormalities in the limbic system can result in agitation, aggression, and other behavioural disturbances.

In summary, the neurobiology of delirium is a complex and multi-faceted phenomenon that involves the interaction of several key brain systems. Understanding the underlying neurobiology is important for the development of effective prevention and treatment strategies.

Delirium is associated with significant morbidity and mortality in the UK. According to recent studies, delirium is a common complication in older adults, particularly those who are hospitalized, and it is associated with a number of adverse outcomes.

A systematic review by Holroyd-Leduc et al. (2010) found that delirium was associated with a two-fold increase in the risk of death in older adults and that this risk remained elevated for up to one year after the episode of delirium. Delirium is a serious condition with significant consequences for the health and well-being of patients in the UK. Effective prevention and management strategies are crucial for reducing the morbidity and mortality associated with delirium.

Symptoms:

An individual suffering from delirium may be:

  • Be prone to distraction
  • Be less conscious of their location or the time (disorientation)
  • Being suddenly incapable of performing a task as well as usual (for example, walking or eating)
  • Be incapable of understanding or following a discourse
  • Have erratic mood swings and hallucinations, which are the seeing or hearing of unreal but frightful objects

Types of Delirium:

(Wilson, 2020)

References:

(1) Holroyd-Leduc, J., Gruneir, A., & Moineddin, R. (2010). Delirium in older adults: a systematic review. The Lancet, 375(9719), 954-962.

(2) Meagher, D. J., & Leonard, M. (2011). Delirium: an overview of its epidemiology, pathogenesis, diagnosis and management. Irish Journal of Psychological Medicine, 28(2), 61-70.

(3) Robinson, T. N., & Inouye, S. K. (2007). Delirium in older adults: an overview. American Journal of Geriatric Psychiatry, 15(9), 710-717.

(4) Trzepacz, P. T. (2001). Delirium: a synthesis of clinical and neurobiological perspectives. Journal of Psychiatry & Neuroscience, 26(5), 271-279.

(5) Wilson, J.E., Mart, M.F., Cunningham, C., Shehabi, Y., Girard, T.D., MacLullich, A.M.J., Slooter, A.J.C. and Ely, E.W. (2020). Delirium. Nature Reviews Disease Primers, [online] 6(1), pp.1–26. doi:https://doi.org/10.1038/s41572-020-00223-4.