Drug-induced delirium

Introduction
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By K K Jain MD

Drug-induced delirium is also known as or subsumes Toxic encephalopathy and Postoperative delirium. -ed.

Delirium is characterized by a reduction of the level of consciousness, and this is manifested clinically by disorientation. This clinical article focuses on medications, which are considered the most common cause of delirium in the hospital setting. Anticholinergic agents are the leading cause of drug-induced delirium; these agents are also an important cause of drug-induced memory disorders. Pathogenesis of delirium is often multifactorial and may involve the interaction of precipitating factors with underlying patient vulnerability because of various risk factors. Awareness of the precipitating factors helps in the prevention of delirium. The clinical article outlines diagnosis and general principles of management. Anticholinergic delirium is best managed by physostigmine, a cholinesterase inhibitor. Donepezil, also a cholinesterase inhibitor, is an effective choice in the management of anticholinergic drug-induced delirium.

Key Points

  • Delirium is an acute, transient disorder of higher nervous system function involving impaired consciousness and attention.
  • Delirium can be drug-induced and is more common in the elderly.
  • Various methods of management include supportive care and withdrawal of the offending drug.
  • Anticholinergic delirium is the only form of delirium for which specific pharmacotherapy is available -- cholinesterase inhibitors.

In This Article

Introduction
Historical note and nomenclature
Clinical manifestations
Etiology
Pathogenesis and pathophysiology
Epidemiology
Prevention
Differential diagnosis
Diagnostic workup
Prognosis and complications
Management
Anesthesia
References cited
Contributors