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Elucidating the pathophysiology of delirium
The neuropathogenesis of delirium has been studied in patients with hepatic encephalopathy and alcohol withdrawal. The main hypothesis is reversible impairment of cerebral oxidative metabolism and multiple neurotransmitter abnormalities.The following observations support the hypothesis of multiple neurotransmitter abnormalities.In delirium, an excess of dopaminergic activity occurs.
Hypoactive delirium presents with lethargy, drowsiness, apathy, decreased responsiveness, or slowed motor skills.
In mixed delirium, individuals display either relatively normal levels of psychomotor activity or rapidly fluctuating levels of activity.
Delirium is defined as a transient, usually reversible, cause of mental dysfunction and manifests clinically with a wide range of neuropsychiatric abnormalities.
It can occur at any age, but it occurs more commonly in patients who are elderly and have a previously compromised mental status.
Cortisol and beta-endorphins: Delirium has been associated with the disruption of cortisol and beta-endorphin circadian rhythms.
This mechanism has been suggested as a possible explanation for delirium caused by exogenous glucocorticoids.A small prospective study among patients who have undergone elective hip replacement surgery showed reduced preoperative plasma cholinesterase activity in as many as one quarter of patients.In addition, reduced preoperative cholinesterase levels were significantly correlated with postoperative delirium. Anticholinergic medications are a well-known cause of acute confusional states, and patients with impaired cholinergic transmission, such those with Alzheimer disease, are particularly susceptible.The clinical hallmarks of delirium are decreased attention or awareness and a change in baseline cognition.Delirium often manifests as a waxing and waning type of confusion.Reorientation techniques or memory cues such as a calendar, clocks, and family photos may be helpful.The environment should be stable, quiet, and well-lighted.Based on the level of psychomotor activity, delirium can be described as hyperactive, hypoactive, or mixed.Hyperactive delirium is observed in patients in a state of alcohol withdrawal or intoxication with phencyclidine (PCP), amphetamine, and lysergic acid diethylamide (LSD).Benzodiazepines often are used for withdrawal states. Delirium is a transient global disorder of cognition.The condition is a medical emergency associated with increased morbidity and mortality rates.