Understanding the Complexity of Delirium

Pathophysiology of Delirium

I thought you might like the complexity of Dr. Jose Maldonado’s conception of the pathophysiology of delirium. It’s complicated enough but the graphics from his presentations at the 2009 Academy of Psychosomatic Medicine (APM) annual meeting, which I could not attend unfortunately, are absolutely priceless. Dr. Maldonado is Associate Professor of Psychiatry and Medicine, Medical Director of the Psychosomatic Medicine Service, and Chief of Forensic Psychiatry at Stanford University Medical Center. He’s done outstanding research, too much for me to describe in this small space, but I must mention the ground-breaking controlled trial comparing Dexmedetomidine in Post-Surgical Valve Disease Patient, published in Psychosomatics in 2009, which demonstrated a reduction of the incidence of delirium using Dexmedetomidine compared to other agents commonly used for sedation in the surgical intensive care unit [1].

In the study, patients were randomized to receive Dexmedetomidine, Propofol, or a combination of Midazolam and Fentanyl. The incidence of delirium was 3% in the Dexmedetomidine group compared with 50% each in the Propofol and Midazolam groups.

Anyway, that’s just to let you know that Dr. Maldonado is a heavy-hitter in delirium research. However, he’s also got a deadly sense of humor, as you can see in these slides excerpted from his lectures on delirium:

The Potential Treatment Strategies for Delirium

Treatment Algorithm of Delirium


The Neurobiology of Delirium

Delirium Neurobiology


I’m sure the attendees had a great time with these. Have fun with a magnifying glass!

1.            Maldonado, J.R., et al., Dexmedetomidine and the reduction of postoperative delirium after cardiac surgery. Psychosomatics, 2009. 50(3): p. 206-17.

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