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Bart Sheehan

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date: 25 February 2021

Delirium is one of the most common psychiatric problems encountered in elderly medical inpatients. It involves a fluctuating cognitive impairment with reduced alertness and often with poorly formed delusions and/or visual hallucinations. The main differential diagnosis is from dementia, although delirium is more likely to develop in patients with existing dementia. Almost any medical condition that affects brain function may cause delirium. Infection is the most common cause, and it is important to consider prescribed drugs as a cause and to remember drug and alcohol withdrawal. Imperatives in management are first to keep the patient safe from harm (they may wander or put themselves in danger), and second to find and correct the cause. Urgent medical investigation and treatment is required as long periods of delirium put the patient at risk of harm, including permanent cognitive impairment.

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