Delirium: where do we stand?

Chi-Un Pae, David M Marks, Changsu Han, Ashwin A Patkar, Prakash Masand
Author Information
  1. Chi-Un Pae: Department of Psychiatry, The Catholic University of Korea College of Medicine, Seoul 137701, South Korea. pae@catholic.ac.kr

Abstract

Clinicians are likely to encounter delirium frequently, particularly in inpatient and intensive care settings. However, delirium is underrecognized and undertreated because of its heterogeneous and fluctuating presentation and due to the limitations in resources and training in contemporary clinical settings. Translation of current knowledge about delirium into clinical practice may improve patient care and benefit public health economics. Hence, this review comprehensively discusses the phenomenology and pathophysiology of delirium and its presenting features, risk factors, differential diagnoses, assessment, prognosis, and treatment with antipsychotics; the goal is to facilitate better prevention, recognition, and treatment of delirium. Available research is reviewed, limitations of the research are discussed, and future directions for further delirium research are identified.

References

  1. Intensive Care Med. 2004 Mar;30(3):444-9 [PMID: 14685663]
  2. JAMA. 2004 Apr 14;291(14):1753-62 [PMID: 15082703]
  3. CMAJ. 2002 Oct 1;167(7):753-9 [PMID: 12389836]
  4. Curr Opin Crit Care. 2005 Aug;11(4):360-8 [PMID: 16015117]
  5. Res Theory Nurs Pract. 2003 Fall;17(3):207-24 [PMID: 14655974]
  6. Nurs Res. 1996 Nov-Dec;45(6):324-30 [PMID: 8941300]
  7. Psychiatry Clin Neurosci. 2001 Oct;55(5):515-9 [PMID: 11555348]
  8. Dement Geriatr Cogn Disord. 1999 Sep-Oct;10(5):330-4 [PMID: 10473933]
  9. Ann Intern Med. 1990 Dec 15;113(12):941-8 [PMID: 2240918]
  10. Arch Intern Med. 2005 Jul 25;165(14):1657-62 [PMID: 16043686]
  11. J Am Geriatr Soc. 2005 Oct;53(10):1658-66 [PMID: 16181163]
  12. Intern Med J. 2007 Dec;37(12):806-11 [PMID: 17517079]
  13. J Am Geriatr Soc. 1975 Oct;23(10):433-41 [PMID: 1159263]
  14. J Pain Symptom Manage. 1997 Mar;13(3):128-37 [PMID: 9114631]
  15. J Psychiatr Res. 1975 Nov;12(3):189-98 [PMID: 1202204]
  16. Age Ageing. 2003 Sep;32(5):525-8 [PMID: 12958002]
  17. Psychiatry Clin Neurosci. 2007 Feb;61(1):67-70 [PMID: 17239041]
  18. Age Ageing. 2005 Mar;34(2):152-6 [PMID: 15713859]
  19. Psychosomatics. 2001 Jan-Feb;42(1):68-73 [PMID: 11161124]
  20. Expert Rev Neurother. 2003 May;3(3):343-55 [PMID: 19810902]
  21. Psychiatry Clin Neurosci. 2005 Apr;59(2):183-8 [PMID: 15823165]
  22. Int Clin Psychopharmacol. 2005 Nov;20(6):311-4 [PMID: 16192839]
  23. Psychosomatics. 2006 Sep-Oct;47(5):385-91 [PMID: 16959926]
  24. Ann Intern Med. 1977 Jan;86(1):40-6 [PMID: 835926]
  25. J Geriatr Psychiatry Neurol. 2003 Mar;16(1):32-8 [PMID: 12641371]
  26. Psychiatry Res. 1988 Jan;23(1):89-97 [PMID: 3363018]
  27. CMAJ. 2001 Sep 4;165(5):575-83 [PMID: 11563209]
  28. Support Care Cancer. 1996 Sep;4(5):390-2 [PMID: 8883234]
  29. N Engl J Med. 1999 Mar 4;340(9):669-76 [PMID: 10053175]
  30. Ann Clin Psychiatry. 2006 Oct-Dec;18(4):267-9 [PMID: 17162627]
  31. Expert Rev Neurother. 2006 May;6(5):741-51 [PMID: 16734522]
  32. Crit Care Med. 2004 Jan;32(1):106-12 [PMID: 14707567]
  33. Cochrane Database Syst Rev. 2004;(2):CD000395 [PMID: 15106152]
  34. Am Fam Physician. 2003 Mar 1;67(5):1027-34 [PMID: 12643363]
  35. J Am Geriatr Soc. 2006 Aug;54(8):1245-50 [PMID: 16913993]
  36. J Clin Psychiatry. 2004 Mar;65(3):348-53 [PMID: 15096074]
  37. JAMA. 1996 Mar 20;275(11):852-7 [PMID: 8596223]
  38. JAMA. 2001 Dec 5;286(21):2703-10 [PMID: 11730446]
  39. J Am Geriatr Soc. 2003 Feb;51(2):234-9 [PMID: 12558721]
  40. J Am Geriatr Soc. 2005 Apr;53(4):622-8 [PMID: 15817008]
  41. Gen Hosp Psychiatry. 2003 Jul-Aug;25(4):289-92 [PMID: 12850662]
  42. Palliat Support Care. 2004 Jun;2(2):171-9 [PMID: 16594247]
  43. Intensive Care Med. 2001 May;27(5):859-64 [PMID: 11430542]
  44. Psychosomatics. 2006 Sep-Oct;47(5):367-75 [PMID: 16959924]
  45. J Clin Psychiatry. 2004 May;65(5):662-7 [PMID: 15163252]
  46. Chest. 2007 Aug;132(2):624-36 [PMID: 17699134]
  47. Geriatr Nurs. 2006 May-Jun;27(3):151-7 [PMID: 16757386]
  48. Cochrane Database Syst Rev. 2007 Apr 18;(2):CD005594 [PMID: 17443602]
  49. Am J Psychiatry. 1999 May;156(5 Suppl):1-20 [PMID: 10327941]
  50. Psychosomatics. 2002 May-Jun;43(3):175-82 [PMID: 12075032]
  51. Intensive Care Med. 2007 Jun;33(6):929-40 [PMID: 17401550]
  52. Ann Clin Psychiatry. 1997 Dec;9(4):219-26 [PMID: 9511945]
  53. Semin Clin Neuropsychiatry. 2000 Apr;5(2):132-48 [PMID: 10837102]
  54. Arch Intern Med. 2007 Jul 9;167(13):1406-13 [PMID: 17620535]
  55. J Clin Psychiatry. 2003 Nov;64(11):1316-21 [PMID: 14658945]
  56. Psychosomatics. 2002 Jan-Feb;43(1):61-2 [PMID: 11927760]
  57. J Geriatr Psychiatry Neurol. 2003 Mar;16(1):29-31 [PMID: 12641370]
  58. J Am Geriatr Soc. 2002 May;50(5):850-7 [PMID: 12028171]
  59. J Am Geriatr Soc. 1989 Aug;37(8):725-9 [PMID: 2754157]
  60. Hum Psychopharmacol. 2004 Mar;19(2):125-7 [PMID: 14994323]
  61. Anesthesiology. 2004 Sep;101(3):794-5 [PMID: 15329607]
  62. Res Theory Nurs Pract. 2003 Spring;17(1):31-50 [PMID: 12751884]
  63. J Am Geriatr Soc. 2006 Mar;54(3):479-84 [PMID: 16551316]
  64. J Neurol Neurosurg Psychiatry. 2008 Feb;79(2):119-25 [PMID: 17519320]
  65. J Am Geriatr Soc. 2005 Mar;53(3):405-9 [PMID: 15743281]
  66. J Am Geriatr Soc. 1994 Mar;42(3):252-6 [PMID: 8120308]
  67. J Am Geriatr Soc. 2006 May;54(5):817-22 [PMID: 16696749]
  68. Prim Care Companion J Clin Psychiatry. 2000 Feb;2(1):10-12 [PMID: 15014661]
  69. Psychosomatics. 1996 Nov-Dec;37(6):533-46 [PMID: 8942204]
  70. J Psychosom Res. 1997 Oct;43(4):417-23 [PMID: 9330241]
  71. Psychosomatics. 2004 Jul-Aug;45(4):297-301 [PMID: 15232043]
  72. Intensive Crit Care Nurs. 2008 Apr;24(2):98-107 [PMID: 17949984]
  73. J Gen Intern Med. 2003 Sep;18(9):696-704 [PMID: 12950477]
  74. J Psychosom Res. 2006 Jul;61(1):123-8 [PMID: 16813854]
  75. J Geriatr Psychiatry Neurol. 2006 Jun;19(2):83-90 [PMID: 16690993]
  76. J Neuropsychiatry Clin Neurosci. 2001 Spring;13(2):229-42 [PMID: 11449030]

MeSH Term

Delirium
Diagnostic and Statistical Manual of Mental Disorders
Humans
Risk Factors
gamma-Aminobutyric Acid

Chemicals

gamma-Aminobutyric Acid

Word Cloud

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