Delirium
Delirium is very underrecognized and underdiagnosed - Sharon Inouye MD

image by: Jorge Royan
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The Perils of Delirium
The disorder can occur at any age — it has been seen in preschoolers — but disproportionately affects people older than 65 and is often misdiagnosed as dementia. While delirium and dementia can coexist, they are distinctly different illnesses. Dementia develops gradually and worsens progressively, while delirium occurs suddenly and typically fluctuates during the course of a day. Some patients with delirium are agitated and combative, while others are lethargic and inattentive.
Patients treated in intensive care units who are heavily sedated and on ventilators are particularly likely to become delirious; some studies place the rate as high as 85 percent. But the condition is common…
Resources
Confusion Assessment Method
Establishes ability to detect delirium in high risk settings.
Delirium Assessment ICU
Monitors delirium in ICU patients.
The Delirium Triage Screen (DTS)
Given its high sensitivity, the DTS is an excellent delirium rule-out screen; if negative, no additional delirium assessment is needed. If the DTS is positive, however, a more specific or confirmatory assessment is needed to rule-in delirium
How You Can Protect Your Parent From Delirium
Paula Duncan looks for delirium, a serious problem that often goes undetected in older hospital patients. So Duncan, a registered nurse at Park Nicollet Methodist Hospital in St. Louis Park, Minn., has learned to look beneath the surface, including in patients’ dreams.
Delirium: How to Prevent this Dangerous Form of Disorientation
Although the young are not exempt, delirium strikes older patients hardest.
Drugs for delirium don’t work, and may in fact harm
Doctors commonly prescribe antipsychotic medications to try to relieve these symptoms. However, our study just published in JAMA Internal Medicine, raises serious concerns about their safety and efficacy. So, what are we to do for people experiencing delirium, who are robbed of their mental awareness and ability to communicate?
Dying of Excitement
Police often blame suspects’ deaths on “excited delirium.” Is that a diagnosis or a cover-up?
Excited Delirium
Excited (or agitated) delirium is characterized by agitation, aggression, acute distress and sudden death, often in the pre-hospital care setting.
Excited delirium: Medical emergency – not willful resistance
The ability to think and act quickly when encountering a patient in an excited delirium situation could spell the difference between successful treatment and a lost life.
Explainer: what is delirium and is it dangerous?
Delirium is dangerous. Compared to patients with the same illness, age and other characteristics who don’t develop delirium, those who do are almost three times more likely to die during, or soon after, hospitalisation.
Hospital-Induced Delirium
Surprisingly common in the elderly, what looks like dementia may be a state of confusion brought on by a mix of meds — and simply being in the hospital.
The Critical Care Experience, A Patient's View
My own experience very much bears out the hypothesis that one benefits from knowing that some of the remembered events really did happen: that one wasn't entirely mad the entire time.
The Hidden Dangers of Going Under
Anesthesia may have lingering side effects on the brain, even years after an operation.
The Overlooked Danger of Delirium in Hospitals
The condition, once known as “ICU psychosis,” disproportionately affects seniors and those who have been heavily sedated—and the delusions can last long after they’re discharged.
Vigilance About the Dangers of Delirium
“We used to think of delirium as inevitable, almost normal,” said Dr. Dale Needham, a critical care specialist at Johns Hopkins. “We now know there are things we can do to reduce the risk.”
When patients suddenly become confused
During illness, hospitalization, or recovery from surgery or stroke, many people experience delirium, a rapidly developing and severe confusion accompanied by altered consciousness and an inability to focus. It's the most common complication of hospitalization among people ages 65 and over...
Excited Delirium: Understanding the Evolution Away from a Controversial Term
For decades, law enforcement officers, medical examiners and emergency medical professionals have used the terms “excited delirium” and “excited delirium syndrome” to describe subjects experiencing extreme agitation, excitability, paranoia and aggression, often associated with stimulant use and certain psychiatric disorders. While officers continue to encounter subjects displaying such symptoms, the term “excited delirium” has come under significant scrutiny and is now disavowed by major medical and psychological organizations..
No Benefit Seen From Antipsychotics Used in Delirious Hospital Patients
Hospitals have given antipsychotics to delirious patients for decades, but a new study found that two of the drugs produced little benefit.
The Relationship Between Delirium And Dementia
Our studies have shown that delirium — an acute confusional state that develops in the face of acute illness, hospitalization, surgery, anesthesia and medications — can lead to long-term cognitive decline and, potentially, dementia. The exact mechanisms of how delirium affects the aging brain remain elusive, and this is an area of active research for my group.
U.S. Doctors abandon "excited delirium" diagnosis used to justify police custody deaths. It might live on, anyway
The term "excited delirium" dates back decades but has never been supported by rigorous scientific studies. Still, the term persisted as some of its early researchers earned money for testifying as expert witnesses in cases involving law enforcement and the company now called Axon Enterprises, which makes the Taser stun gun. The theory suggested that agitated, delirious individuals were dying not because they had been shocked by stun guns, restrained with chokeholds, or held facedown so they couldn't breathe, but because of this unexplained medical condition that could lead to sudden death.
Adult Non-ICU Care: Monitoring Delirium
The Delirium Triage Screen (DTS) was designed to be the optional first step of a two-step delirium monitoring process for very busy clinical environments. The DTS is a 20 second assessment designed to rapidly rule-out delirium and reduce number of formal delirium assessments needed.
Excited delirium: valid clinical diagnosis or medicalized racism? Organized medicine needs to take a stand
The “diagnosis” of excited delirium, a term often used to justify and defend police brutality, disproportionately against Black people, has circulated in the medical canon for more than 25 years. It is time — past time, actually — for organized medicine to denounce its diagnostic validity and its use as a shield to justify excessive police force.
The Perils of Delirium
The disorder can occur at any age — it has been seen in preschoolers — but disproportionately affects people older than 65 and is often misdiagnosed as dementia. While delirium and dementia can coexist, they are distinctly different illnesses.
Art and Science of Delirium
This blog serves as a point of synthesis of art practice and medical science. The goals are to share perspectives between art and science and other disciplines that might lead to new diagnostic techniques, advancement in clinician, patient and public education on illness and health, and new topics for medical research that broaden our understanding of what it means to be human.
ICU Delirium
We advance knowledge, education, and models of care for people affected by critical illness.
Emergency Department Delirium
It is an independent predictor of short-term and long-term mortality across multiple clinical environments. Approximately one out of three older emergency department patients with delirium will die within 6-months.

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