2.4 Delirium

Dr. Mark Oldham, Associate Professor of Psychiatry at University of Rochester Medical Center, President-Elect of the American Delirium Society, and Deputy Editor of the Journal of the Academy of Consultation-Liaison Psychiatry, takes us through a deep dive on delirium. This episode covers an enormous amount of material. We contrast encephalopathy and delirium before diving into the dangerousness of delirium and prevention strategies. We explore the neurobiology of delirium and tie it to validated assessment tools and treatment approaches. We also discuss areas for future research and learn to appreciate the evolutionary function that delirium serves.

References:

1. (3:38) ⁠Lipowski ZJ. Delirium: Acute Brain Failure in Man. Springfield, IL: Charles C Thomas, 1980. ⁠
2. (7:55) ⁠Slooter AJC, Otte WM, Devlin JW, et al. Updated nomenclature of delirium and acute encephalopathy: statement of ten Societies. Intensive Care Med. 2020;46(5):1020-1022. ⁠
3. (21:46)  ⁠Marcantonio ER, Ngo LH, O’Connor M, et al. 3D-CAM: derivation and validation of a 3-minute diagnostic interview for CAM-defined delirium: a cross-sectional diagnostic test study [published correction appears in Ann Intern Med. 2014 Nov 18;161(10):764]. Ann Intern Med. 2014;161(8):554-561. ⁠ 
4. (29:50) ⁠Kunicki ZJ, Ngo LH, Marcantonio ER, et al. Six-Year Cognitive Trajectory in Older Adults Following Major Surgery and Delirium. JAMA Intern Med. 2023;183(5):442-450.  ⁠
5. (41:40) ⁠Mews MR, Tauch D, Erdur H, Quante A. Comparing consultation-liaison psychiatrist’s and neurologist’s approaches to delirium – A retrospective analysis. Int J Psychiatry Med. 2016;51(3):284-301. ⁠=
6. (1:08:08) ⁠Girard TD, Exline MC, Carson SS, et al. Haloperidol and Ziprasidone for Treatment of Delirium in Critical Illness. N Engl J Med. 2018;379(26):2506-2516. ⁠ 
7. (1:09:33) ⁠Hui D, Frisbee-Hume S, Wilson A, et al. Effect of Lorazepam With Haloperidol vs Haloperidol Alone on Agitated Delirium in Patients With Advanced Cancer Receiving Palliative Care: A Randomized Clinical Trial. JAMA. 2017;318(11):1047-1056.
8. (1:31:36) ⁠By the 2023 American Geriatrics Society Beers Criteria® Update Expert Panel. American Geriatrics Society 2023 updated AGS Beers Criteria® for potentially inappropriate medication use in older adults. J Am Geriatr Soc. 2023;71(7):2052-2081.
9. (1:33:54) ⁠Burton JK, Craig LE, Yong SQ, et al. Non-pharmacological interventions for preventing delirium in hospitalised non-ICU patients. Cochrane Database Syst Rev. 2021;7(7):CD013307. Published 2021 Jul 19.  ⁠
10. (1:35:41) ⁠Skrobik Y, Duprey MS, Hill NS, Devlin JW. Low-Dose Nocturnal Dexmedetomidine Prevents ICU Delirium. A Randomized, Placebo-controlled Trial. Am J Respir Crit Care Med. 2018;197(9):1147-1156. ⁠ 
11. (1:36:00) ⁠Subramaniam B, Shankar P, Shaefi S, et al. Effect of Intravenous Acetaminophen vs Placebo Combined With Propofol or Dexmedetomidine on Postoperative Delirium Among Older Patients Following Cardiac Surgery: The DEXACET Randomized Clinical Trial [published correction appears in JAMA. 2019 Jul 16;322(3):276]. JAMA. 2019;321(7):686-696. 
12. (1:41:00) Oldham MA, Flanagan NM, Khan A, Boukrina O, Marcantonio ER. Responding to Ten Common Delirium Misconceptions With Best Evidence: An Educational Review for Clinicians. J Neuropsychiatry Clin Neurosci. 2018;30(1):51-57. doi:10.1176/appi.neuropsych.17030065