Delirium history and symptoms

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Sara Zand, M.D.[2] Pratik Bahekar, MBBS [3]; Vishal Khurana, M.B.B.S., M.D. [4]


Delirium causes impairment in functions, sleep-wake cycle and also has a behavioral component. Common symptoms associated with delirium include altered level of consciousness, inattention, disorientation, hallucination, delusions, agitation, inappropriate speech, sleepwake disturbances, Symptom fluctuation, emotional disturbance. Subclinical delirium or prodromal delirium may precede by 1 to 3 days prior to an overt delirium, which presents as restlessness, anxiety, irritability, distractibility, sleep disturbance with less severe cognitive impairment in comparison to delirium.


Common symptoms associated with delirium include:


  • Simple cognitive testing such as Mini-mental Scale examination should be administered in all elderly patients admitted to hospital. However these test can not differentiate delirium from other cognitive disorders.[3]
  • Serial measurement maybe helpful to detect new-onset delirium.
  • History from relatives is often useful to determine the onset, progress, and duration of delirium. Patients with confusional states may not provide an accurate history.
  • A detailed history must include the following:
  1. History of prescribed and non‑prescribed medicines
  2. History of alcohol and other recreational drugs
  3. History of activities of daily living such as payment of bills
  4. Onset, progression and duration of confusion
  5. Previous history of acute or chronic confusion
  6. Social circumstances and support
  7. Any other co-morbid illness such as epilepsy
  8. Symptoms suggestive of underlying cause (infection)
  9. Motor or sensory deficits
  10. Aids used ( hearing aid, glasses)

Commonly Co-Occurring Mental Symptoms, with a note on Severity

Inability to Focus Attention, Confusion and Disorientation

Memory Formation Disturbance

Abnormalities of Awareness and Affect


  1. Serafim, Rodrigo B.; Soares, Marcio; Bozza, Fernando A.; Lapa e Silva, José R.; Dal-Pizzol, Felipe; Paulino, Maria Carolina; Povoa, Pedro; Salluh, Jorge I. F. (2017). "Outcomes of subsyndromal delirium in ICU: a systematic review and meta-analysis". Critical Care. 21 (1). doi:10.1186/s13054-017-1765-3. ISSN 1364-8535.
  2. "Practice guideline for the treatment of pati... [Am J Psychiatry. 1999] - PubMed - NCBI".
  3. Mitchell, Alex J.; Shukla, Deepak; Ajumal, Hafsa A.; Stubbs, Brendon; Tahir, Tayyeb A. (2014). "The Mini-Mental State Examination as a diagnostic and screening test for delirium: systematic review and meta-analysis". General Hospital Psychiatry. 36 (6): 627–633. doi:10.1016/j.genhosppsych.2014.09.003. ISSN 0163-8343.
  4. Lippmann S, Perugula ML (2016). "Delirium or Dementia?". Innov Clin Neurosci. 13 (9–10): 56–57. PMC 5141598. PMID 27975002.
  5. Thom, Robyn P.; Levy-Carrick, Nomi C.; Bui, Melissa; Silbersweig, David (2019). "Delirium". American Journal of Psychiatry. 176 (10): 785–793. doi:10.1176/appi.ajp.2018.18070893. ISSN 0002-953X.

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