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The term delirium is used to refer to a syndrome composed of the following -- disturbances of sleep, disturbances of attention, thought disturbance, and often, neuromotor findings.


It has a high level of similarity to psychosis.


Delirium is believed to be caused by CNS metabolism illness, which in turn, is typically attributed to systemic illness.


For example, the most common cause of derlium, in our society, is cardiac disease. When cardiac disease occurs, a wide range of metabolic disturbances occur. Electrolyte impalances can occur. endocrine disturbances (in secretion of peptides such as vasopressin) occur. Anoxic injury can occur, leading to a wide range of losses of physiologic functions. cumulatively, when these have an impact on the CNS, the end point injury is to the cogntiive process that allows attention to dates, times, time of day, other features of diurnal cycle, and awareness of physical surroundings.


At one point in the past, physicians would refer to this cumulative loss as "disturbance of sensorium".


The only long term treatment for delirium is treatment of the underlying illness. However, one often finds a physician's consult report asking that treatments with neuroleptics be used. Why is this ?


Because neuroleptics act on CNS circuitry, and are believed to be beneficial to contrlling those aspects of delirium that impair a patient's capacity to make decisions and carry them out. Is there any evidence to show a reduction in mortality or morbidity from treatment of delirium with neuroleptics ?


One reason I have established this Wiki is to allow psychiatrist to put foward their best understanding of clinical outcomes of different approaches to illness. So we will await citations demonsstrating the case for either side of this question.


My own sense is that delirium should be treated by a psychiatrist, but that this may also include an inquiry as to the possible presence of undiagnosed pre - existing illnesses that are often not noted by internists, such as Alzheimer's diease, acute stroke, other CNS vascular dieases, head injuries, metabolic diseases, and familial neurologic illnesses.

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