Psychiatric Approach to Delirium

Psychiatry & Psychotherapy Podcast

David J Puder

Science, Health & Fitness, Medicine

4.8 • 1.3K Ratings

🗓️ 8 October 2018

⏱️ 50 minutes

🔗️ Recording | iTunes | RSS

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Summary

Delirium is an acute change in a person’s sensorium (the perception of one’s environment or understanding of one’s situation). It can include confusion about their orientation, cognition or mental thinking.

With hyperactive delirium, a patient can become aggressive, violent and agitated with those around them. A patient experiencing delirium can have hallucinations and hear things, they can become paranoid, and they are overall confused. A family or non-psychiatric medical staff might be concerned that the patient is experiencing something like schizophrenia.

Hyperactive delirium symptoms in patients:

Waxing and waning —it comes and goes

Issues with concentration

Pulling out medical lines

Yelling profanities

Throwing things

Agitated

Responding to things in the room that aren’t there

Not acting like themselves

Hypoactive delirium is much more common than hyperactive delirium (based on research studies), but it is often missed because the presentation is much less dramatic. People with hypoactive delirium are confused and disoriented, but they are not expressing their confusion verbally or physically.

Hypoactive delirium symptoms:

Slower movement

Softer speech

Slower responses

Withdrawn

Not eating as much

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Transcript

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0:00.0	Welcome to the Psychiatry and Psychotherapy Podcast. The podcast to help you in your journey
0:06.0	towards becoming a wise, empathic, genuine and connected mental health professional.
0:11.0	I'm your host, Dr. David Pewter, a psychiatrist who splits his time practicing psychopharmacology,
0:17.0	individual and group psychotherapy, medical director of a day treatment program,
0:21.0	medical education research, and teaching residents and medical students.
0:30.0	So welcome to the podcast. I am here with Dr. Timothy Lee. Dr. Timothy Lee is the
0:41.0	Loma Linda Residency Program Director. He is also the head of the consult and liaison services.
0:50.0	Those are the people that get consulted on medical patients in the actual hospital.
0:56.0	And one of the main things that he gets consulted on is delirium.
1:03.0	And so Dr. Lee, how would you define delirium?
1:07.0	So thanks for having me, David. I'm flattered to be chosen to be a part of the podcast. Hopefully it's interesting.
1:16.0	But yeah, to the question, delirium we basically think of as an acute change in a person's
1:25.0	synsorium, which can include, you know, their orientation, their cognition or mental thinking.
1:35.0	But yeah, basically, in essence, an acute change in their cognition or their synsorium.
1:43.0	So define synsorium.
1:47.0	So synsorium can involve one's perception of one's environment.
1:54.0	So stimuli in the environment, it can involve one's understanding of one's situation, such as where one is,
2:04.0	what the current date is, what their recent events might have been.
2:12.0	Yeah. So you're in the hospital.
2:14.0	Mm-hmm.
2:15.0	You have, let's say, a hip injury.
2:17.0	Yeah.
	...

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