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Chapter 10. Delirium Due to a General Medical Condition, Delirium Due to Multiple Etiologies, and Delirium Not Otherwise Specified

Donald M. Hilty, M.D.; Andreea L. Seritan, M.D.; James A. Bourgeois, O.D., M.D.; Sally C. Klein, R.N.; Peter M. Yellowlees, M.D.
DOI: 10.1176/appi.books.9781585622986.252788

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Excerpt

Delirium occurs in 10%–30% of patients on medical and surgical wards. The frequency of delirium increases with advanced age, existing brain disease (e.g., dementia of the Alzheimer's type, cerebrovascular accidents, and head trauma), and severe medical disorders (e.g., cancer, human immunodeficiency virus [HIV]) (Fick et al. 2002; Kolbeinsson and Jónsson 1993). Delirium "is a sign of impending death in 25% of cases" (Folstein et al. 1991, p. 169) and is associated with longer lengths of hospital stay (Francis et al. 1990; Inouye et al. 1998), poorer functional recovery (Murray et al. 1993), and increased risk for nursing home placement (Inouye et al. 1998).

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Figure 10–1. Comparison of electroencephalogram, constructional apraxia testing, and mental status findings in delirium.Source. Reprinted from Wise MG: "Delirium," in The American Psychiatric Press Textbook of Neuropsychiatry. Edited by Hales RE, Yudofsky SC. Washington, DC, American Psychiatric Press, 1987, pp. 89–105. Copyright 1987, American Psychiatric Press. Used with permission.
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Table 10–1. Prevalence of delirium
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Table 10–2. Clinical features of delirium
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Table 10–3. Assessment of the (potentially) delirious patient
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Table 10–4. Differential diagnosis for delirium: WITCHED—TM
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Table 10–5. Interventions with physicians, units, hospitals, and allied facilities
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Table 10–6. Medical management of delirium
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Table 10–7. Pros and cons of medications used for agitation and delirium

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