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Delirium, drugs, toxins 

Delirium, drugs, toxins
Chapter:
Delirium, drugs, toxins
Author(s):

Barbara C. van Munster

, Sophia E. de Rooij

, and Sharon K. Inouye

DOI:
10.1093/med/9780199655946.003.0022
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date: 07 June 2020

Delirium is a highly prevalent neuropsychiatric syndrome. It is defined by acute disturbance in attention, a change in cognition, or a perceptual derangement. Delirium can be precipitated by any somatic factor, which includes a variety of different illnesses, surgery, or substance (medication) intoxication or withdrawal. Predisposing factors are higher age and cognitive and functional impairment, among others. A final common pathway seems to be the most plausible for this multifactorial syndrome. The current leading candidate for the final pathway is the neurotransmitter state of relative acetylcholine deficiency and dopamine excess, together with an exaggerated inflammatory cascade. Although prevention of delirium should be the main aim, treatment consists of non-pharmacologic measures, reversing the precipitating conditions, and judicious use of antipsychotics in severely agitated patients only. Delirium is independently associated with an increase in mortality, impaired physical and cognitive recovery, and increased hospital costs.

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