Diagnosis And Management of Acute Mental Status Changes: Delirium

Delirium, or acute confusional state, is a syndrome characterized by an acute change in cognition with altered consciousness and impaired attention that fluctuates over time. It is a common diagnosis in the hospitalized patient, especially in the elderly, and can be associated with serious complications. Delirium often goes unrecognized and untreated. Symptoms are wide ranging, thus a clinical diagnosis can be missed without a formal assessment. The following module provides hospitalists with methods for diagnosing and managing delirium. A management strategy for the prevention and treatment of alcohol withdrawal delirium is also discussed.

Provide hospitalists with current diagnosis and management strategies for patients with delirium.

This activity is designed for hospitalists. No prerequisites required.

After completing the module, the participant should be able to:

1. Diagnose delirium and characterize the sub-types.
2. Describe the morbidity and mortality associated with delirium, identify the incidence and prevalence of delirium in the inpatient setting, and explain the reasons for the high non-detection rates.
3. List the predisposing and precipitating risk factors for developing delirium and discuss prevention strategies in the high-risk patient.
4. Appreciate delirium as a medical urgency and describe an approach to the evaluation of delirium.
5. Discuss nonpharmacologic and pharmacologic treatment strategies for delirium.
6. Describe a management strategy for the prevention and treatment of alcohol withdrawal delirium.

The Johns Hopkins University School of Medicine takes responsibility for the content, quality, and scientific integrity of this CME activity.

Accreditation Statement: The Johns Hopkins University School of Medicine is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.

Credit Designation Statement: The Johns Hopkins University School of Medicine designates this educational activity for a maximum of 2 AMA PRA Category 1 Credit(s)^™. Physicians should only claim credit commensurate with the extent of their participation in the activity.

Release date: August 2008. Expiration date: August 2012

Estimated time to complete activity: 2 hours

Full Disclosure Policy Affecting CME Activities: As a provider accredited by the Accreditation Council for Continuing Medical Education (ACCME), it is the policy of The Johns Hopkins University School of Medicine to require the disclosure of the existence of any significant financial interest or any other relationship a faculty member or a sponsor has with the manufacturer(s) of any commercial product(s) discussed in an educational presentation. The presenting faculty reported the following:

^*Hospitalist and Instructor of Medicine, Department of Medicine, Brigham and Women’s Hospital; Harvard Medical School, Boston, Massachusetts.

Conflict of Interest: Dr Crumlish reports having no significant financial or advisory relationships with corporate organizations related to this activity.

Off-Label Product Discussion: There is no drug with US Food and Drug Administration (FDA) approval for the treatment of delirium. Intravenous haloperidol does not have FDA approval.

Disclaimer: The opinions and recommendations expressed by faculty and other experts whose input is included in this program are their own. This enduring material is produced for educational purposes only. Use of Johns Hopkins University School of Medicine name implies review of educational format design and approach. Please review the complete prescribing information of specific drugs or combination of drugs, including indications, contraindications, warnings and adverse effects before administering pharmacologic therapy to patients.

Address correspondence to: Colleen M. Crumlish, MD, 3400 Spruce Street, Penn Tower Suite 2009, Philadelphia, PA 19104. E-mail: colleen.crumlish@uphs.upenn.edu.

Click here to download the references for this educational activity.

The following is an interactive educational module designed to help you gauge your basic knowledge of the topic and then direct you to areas you may need to focus on. It consists of 3 sections: an unaccredited pre-test, a study program, and a CME post-test. All 3 sections must be completed to receive CME credit.

Supported by an educational grant from Merck & Co., Inc.