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Sherry Roberts 

Week 8 Delirium

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Delirium

Delirium is said to be a common, quick onset, and life -threatening problem. It can be misdiagnosed as dementia. Delirium effects the attention span and not so much the memory. This leads to the DSM-5 criteria for delirium. Disturbance in attention, develops withing hours to a few days, disturbance in cognition such as memory deficits, perception, language, or disorientation that aren’t explained by any other neurocognitive disorder. It has to have evidence of another medical condition or substance intox. or withdrawal (European Delirium Association and American Delirium Society, 2014). Certain specific brain regions that are involved in delirium have been identified, such as the prefrontal cortex, the thalamus and the basal ganglia, especially in the nondominant hemisphere. Functional changes occur in a large number of neurotransmitters: the most frequent and best characterized are a reduction of cholinergic function and an increase in dopaminergic and GABAergic function, although alterations in almost all neurotransmitter systems (serotoninergic, noradrenergic, glutaminergic, histaminergic) have been found (Fernandez & Cruz-Jentoft, 2009).

Psychotherapy and Psychopharmacology

In treating delirium, the underlying medical conditions need to be corrected. According to Pahwa, et, al., The use of antipsychotics can make delirium worse and cause severe EPS. Side effects such as EPS, aspiration pneumonia, and arrhythmia are concerns when using antipsychotics for delirium treatment. Most importantly, the FDA warns that there is an increased risk of death (Pahwa, Qureshi, & Cumbler, 2019). With that being said, there is a window of opportunity where antipsychotic medications will be used. The efficacy of antipsychotic medications for the treatment of delirium is controversial. Although some studies suggest that the benefits of using antipsychotics outweigh the risks when used to manage specific target symptoms (e.g., agitation, paranoia, psychosis) (Thom, Levi-Carrick, Bui, & Silbersweig, 2019). Psychotherapy is not going to be useful during an episode of delirium. Psychotherapy could be helpful after the patient has recovered. The nonpharmacological approaches available include reorientation and behavioral intervention. Only a limited number of trials have examined the efficacy of cognitive, emotional and environmental interventions in delirium, but the use of such supportive measures has nevertheless become standard practice on the basis of clinical experience, common sense, and lack of adverse effects (Fong, Tulebaev, & Inouye, 2009). In other words, the risk is low if psychotherapeutic techniques are used.

 

References

European Delirium Association and American Delirium Society. (2014, September 25, 2014). The DSM-5 criteria, level of arousal and delirium diagnosis: inclusiveness is safer. US National Library of Medicine, 12, 141. https://doi.org/doi: 10.1186/s12916-014-0141-2

Fernandez, F. V., & Cruz-Jentoft, A. J. (2009). [Delirium: etiology and pathophysiology]. NIH, 4-12. https://doi.org/PMID: 19422109

Fong, T. G., Tulebaev, S. R., & Inouye, S. K. (2009, April 2009). Delirium in elderly adults: diagnosis, prevention and treatment. US National Library of Medicine, 210-220. https://doi.org/doi: 10.1038/nrneurol.2009.24

Pahwa, A. K., Qureshi, I., & Cumbler, E. (2019, March 20, 2019). Things We Do for No Reason: Use of Antipsychotic Medications in Patients with Delirium. The Journal of Hospital Medicine, 565-567. Retrieved from https://www.journalofhospitalmedicine.com/jhospmed/article/195967/hospital-medicine/things-we-do-no-reason-use-antipsychotic-medications

Thom, R. P., Levi-Carrick, N. C., Bui, M., & Silbersweig, D. (2019, October 1. 2019). Delirium. The American Journal of Psychiatry. https://doi.org/https://doi.org/10.1176/appi.ajp.2018.18070893

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