The phenomenology of delirium has received little standardized longitudinal study but offers the prospect of valuable insights regarding clinical subtypes, differentiation from other neuropsychiatric disorders, identification of underlying pathophysiologies, management, and course. This review examines current approaches to the investigation of delirium phenomenology and how the findings to date illuminate our understanding of delirium. It concludes with recommendations for future investigations.
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References
1.
ThomasRICameronDJFahsMC. A prospective study of delirium and prolonged hospital stay. Arch Gen Psychol1988; 45: 937940
2.
RabinsPVFolsteinMF. Delirium and dementia: diagnostic criteria and fatality rates. Br J Psychiatry1982; 140: 149153
3.
FrancisJ. Delirium in older patients. J Am Geriatr Soc1992; 40: 829838
4.
RockwoodKCoswaySStoleePKyddDIncreasing the recognition of delirium in elderly patients. J Am Geriatr Soc1994; 42: 252256
5.
FrancisJMartinDKapoorWN. A prospective study of delirium in hospitalized elderly. JAMA1990; 263: 10971101
6.
LipowskiZJ. Delirium: acute confusional states. New York: Oxford University Press, 1990
7.
NicholasLMLindseyBA. Delirium presenting with symptoms of depression. Psychosomatics1995; 36: 471479
8.
TreloarAJMacdonaldAJD. Outcome of delirium: Part 2. Clinical features of reversible cognitive dysfunction- are they the same as accepted definitions of delirium?Int J Geriatr Psychol1997; 12: 614618
9.
TrzepaczPTBrennerRPCoffmanGDelirium in liver transplantation candidates: discriminant analysis of multiple test variables. Biol Psychiatry1988; 24:3–14
10.
LevkoffSEEvansDALiptzinBADelirium. The occurrence and persistence of symptoms among elderly hospitalized patients. Arch Intern Med1992; 152: 334340
11.
American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 4th Ed.Washington, DC: APA, 1994
12.
TrzepaczPT. The neuropathogenesis of delirium. A need to focus our research. Psychosomatics1994; 35: 374391
13.
TrzepaczPTMulsantBHDewMAIs delirium different when it occurs in dementia? A study using the delirium rating scale. J Neuropsychiatry Clin Neurosci1998; 10: 199204
14.
LiptzinBLevkoffSEGottliebGDelirium: background paper for DSM-IV. J Neuropsychiatry Clin Neurosci1993; 5: 154160
15.
MacdonaldAJDTreloarAJ. Delirium and dementia; are they distinct?J Am Geriatr Soc1996; 44: 10011002
16.
MulsantBHRosenJ. Dementia (Alzheimer's disease). In: HersenMAmmermanT eds. Handbook of prescriptive treatments for adults. New York: Plenum, 1994:3151
17.
FrancisJKapoorWN. Prognosis after hospital discharge of older medical patients with delirium. J Am Geriatr Soc1992; 40: 601606
18.
KoponenHJLeinonenELepolaUReikkinenPJ. Along term follow-up study of cerebrospinal fluid somatostatin in delirium. Acta Psychiatr Scand1994; 89: 329334
19.
PompeiPForemanMRudbergMADelirium in hospitalized older persons: outcomes and predictors. J Am Geriatr Soc1994; 42: 809815
20.
JacobsonSALeuchterAFWalterDO. Conventional and quantitative EEG in the diagnosis of delirium among the elderly. J Neurol Neurosurg Psychiatry1993; 56: 153158
21.
LipowskiZJ. Delirium: acute brain failure in man. Springfield, IL: Charles C. Thomas, 1983
22.
MeagherDJO'HanlonDO'MahonyEThe relationship between symptoms and motoric subtype in delirium. Submitted for publication
23.
RossCAPeyserCEShapiroIDelirium: phenomenologic and etiologic subtypes. Int Psychogeriatr1991; 3: 135147
FigielGSKrishnanKRBreitnerJCRadiologic correlates of antidepressant-induced delirium: the possible significance of basal ganglia lesions. J Neuropsychiatry Clin Neurosci1989; 1: 188190
37.
FigielGSHassenMAZorumskiCECT-induced delirium in depressed patients with Parkinson's disease. J Neuropsychiatry Clin Neurosci1991; 3: 405411
38.
CuttingJ. The right hemisphere and psychiatric disorders. New York: Oxford University Press, 1990
39.
ProJDWellsCE. The use of the electroencephalogram in the diagnosis of delirium. Disord Nerv System1977; 38: 804808
40.
BrennerRP. Utility of EEG in delirium: past views and current practice. Int Psychogeriatr1991; 3: 211229
41.
AndreasenNJCHartfordCEKnottJREEG changes associated with burn delirium. Disord Nerv System1997; 38: 2731
42.
MatsushimaENakajimaKMoriyaHA psychophysiological study of the development of delirium in coronary care units. Biol Psychiatry1997; 41: 12111217
43.
ItilTFinkM. Anticholinergic drug-induced delirium: experimental modification, quantitative EEG and behavioural correlations. J Nerv Ment Dis1966; 143: 492507
44.
GreeneLT. Physostigmine treatment of anticholinergic depression in postoperative patients. Anesth Analg1971; 50: 222226
45.
TuneLCarrSHoagEAnticholinergic effects of drugs commonly prescribed for the elderly: potential means for assessing risk of delirium. Am J Psychiatry1992; 149: 13931394
46.
TuneLCarrSCooperTAssociation of elevated anticholinergic activity of prescribed medications with postoperative delirium. J Neuropsychiatry Clin Neurosci1993; 5: 208210
47.
TrzepaczPT. Anticholinergic model for delirium. Semin Clin Neuropsychiatry1996; 1: 294303
48.
TrzepaczPTHoVMallavarapuH. Cholinergic delirium and neurotoxicity associated with tacrine for alzheimer's dementia. Psychosomatics1996; 37: 299301
49.
LayneOLYudofskySC. Postoperative psychosis in cardiotomy patients. N Engl J Med1971; 284: 518520
50.
LazarusHRHagensJH. Prevention of psychosis following open heart surgery. 1968; 124:7681
51.
WilliamsMACampbellEBRaynorWJReducing acute confusional states in elderly patients with hip fractures. Res Nurs Health1985; 8: 329337
52.
ColeMGPrimeauFJBaileyRFSystematic intervention for elderly inpatients with delirium: a randomized trial. Can Med Assoc J1994; 151: 965970
53.
InouyeS. Delirium in hospitalized elderly patients: recognition, evaluation and management. Conn Med1993; 5730957315
54.
InouyeSK. The dilemma of delirium: clinical and research controversies regarding diagnosis and evaluation of delirium in hospitalized elderly medical patients. Am J Med1994; 7: 278288
55.
WeddingtonWW. The mortality of delirium: an underappreciated problem?Psychosomatics1982; 23: 12321235
56.
WadaYYamaguchiN. Delirium in the elderly: relationship of clinical symptoms to outcome. Dementia1993; 4: 113116
57.
ReyesRLBhattacharyyaAKHellerD. Traumatic head injury: restlessness and agitation as prognosticators of physical and psychological improvement in patients. Arch Phys Med Rehabil1981; 62: 2023
58.
SiroisF. Delirium: 100 cases. Can J Psychiatry1988; 33: 375378
59.
TreloarAJMacdonaldAJD. Outcome of delirium: Part 1. Int J Geriatr Psychol1997; 12: 609613
60.
FrancisJKapoorWN. Acute mental change: when are head scans needed?Clin Res1991; 39:575A
61.
WolffHGCurranD. Nature of delirium and allied states: the dysergastic reaction. Arch Neurol Psychiatry1935; 33: 11751215
62.
MeagherDJO'HanlonDO'MahonyERelationship between etiology and phenomenologic profile in delirium. J Geriatr Psychiatry Neurol1998; 11: 146149
63.
PlattMMBreitbartWSmithMEfficacy of neuroleptics for hypoactive delirium. J Neuropsychiatry Clin Neurosci1994; 6: 66
64.
RockwoodK. The occurrence and duration of symptoms in elderly patients with delirium. J Gerontol Med Sci1993; 48:M162–M166
65.
MorseRMLitinEM. The anatomy of delirium. Am J Psychiatry1971; 128: 111116
66.
JohnsonJCGottliebGLSullivanEUsing DSM-III criteria to diagnose delirium in elderly general medical patients. J Gerontol1990; 45:M11–M119
