In the Clinic
6 October 2020

Delirium

Publication: Annals of Internal Medicine
Volume 173, Number 7

Abstract

Delirium is an acute confusional state that is common and costly and is associated with significant functional decline and distress. It is the manifestation of acute encephalopathy and is variably called acute brain failure, acute brain dysfunction, or altered mental status. All patients are at risk for delirium, although those with more vulnerabilities (such as advanced age, exposures to other stressors like infection, and certain medications) are at higher risk. The pathophysiologic cause of delirium is not well understood. It is important to recognize patients at risk for and those with delirium and to immediately identify and treat factors contributing to it. There is no single intervention or medication to treat delirium, making it challenging to manage. Therefore, risk mitigation and prompt treatment rely on a sophisticated strategy to address the contributing factors. Delirium may be prevented or attenuated when multimodal strategies are used, thereby improving patient outcomes.

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Information & Authors

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Published In

cover image Annals of Internal Medicine
Annals of Internal Medicine
Volume 173Number 76 October 2020
Pages: ITC49 - ITC64

History

Published online: 6 October 2020
Published in issue: 6 October 2020

Keywords

Authors

Affiliations

Melissa L.P. Mattison, MD
Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts (M.L.M.)
CME Objective: To review current evidence for screening, prevention, diagnosis, treatment, and practice improvement of delirium.
Acknowledgment: The author thanks Edward R. Marcantonio, MD, author of the previous version of this In the Clinic.
Funding Source: American College of Physicians.
Disclosures: Dr. Mattison, ACP Contributing Author, has nothing to disclose. The form can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M20-0850.
Editors' Disclosures: Christine Laine, MD, MPH, Editor in Chief, reports that her spouse has stock options/holdings with Targeted Diagnostics and Therapeutics. Cynthia D. Mulrow, MD, MSc, Senior Deputy Editor, reports that she has no relationships or interests to disclose. Deborah Cotton, MD, MPH, Deputy Editor, reports that she has no financial relationships or interests to disclose. Eliseo Guallar, MD, MPH, DrPH, Deputy Editor, Statistics, reports that he has no financial relationships or interests to disclose. Christina C. Wee, MD, MPH, Deputy Editor, reports employment with Beth Israel Deaconess Medical Center. Sankey V. Williams, MD, Deputy Editor, reports that he has no financial relationships or interests to disclose. Yu-Xiao Yang, MD, MSCE, Deputy Editor, reports that he has no financial relationships or interest to disclose.
With the assistance of additional physician writers, the editors of Annals of Internal Medicine develop In the Clinic using MKSAP and other resources of the American College of Physicians. The patient information page was written by Monica Lizarraga from the Patient and Interprofessional Partnership Initiative at the American College of Physicians.
In the Clinic does not necessarily represent official ACP clinical policy. For ACP clinical guidelines, please go to https://www.acponline.org/clinical_information/guidelines/.

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Melissa L.P. Mattison. Delirium. Ann Intern Med.2020;173:ITC49-ITC64. [Epub 6 October 2020]. doi:10.7326/AITC202010060

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