Delirium is a syndrome most commonly found in the older population. The DSM-IV contains 4 criteria for delirium which may be remembered using the following ‘poem’:
“Consciousness, cognition, fluctuation, Secondary to a medical condition.”
For your reference, here are the 4 DSM-IV criteria for delirium:
- Disturbance of consciousness with reduced ability to focus, sustain or shift attention.
- Changes in cognition or perceptual disturbances not better accounted for by a preexisting, established or evolving dementia.
- The disturbances develop over a short period of time (hours to days) and fluctuate over the course of the day.
- The disturbance is caused by the direct physiological consequences of a general medical condition.
The medical conditions cause delirium are contained in the somewhat disturbingly named mnemonic “I WATCH DEATH”:
I = Infectious (e.g. UTI, pneumonia, encephalitis)
W = Withdrawal (e.g. alcohol, benzodiazepines, barbiturates)
A = Acute metabolic disorder (e.g. electrolyte disturbance, liver/kidney failure)
T = Toxins/drugs (e.g. alcohol, benzodiazepines, opiates, anticholinergics, steroids, NSAIDS, dopamine agonists)
C = CNS pathology (e.g. stroke, tumour, seizure, infection)
H = Hypoxia (e.g. anemia, heart failure, PE)
D = Deficiencies in nutrients (e.g. thiamine, folate, B12)
E = Endocrinopathy (e.g. thyroid, hypo/hyperglycemia, hyperparathyroidism, adrenal insufficiency)
A = Acute vascular (e.g. shock, hypertensive encephalopathy)
T= Trauma (e.g. postoperative, head injury)
H = Heavy metal (e.g. lead, mercury, arsenic)
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