Delirium: Time to Transcend the News Reports and Work on the Problem

Some people thought the news article on delirium, which has been republished a few times, could have gone further to characterize delirium as a life-threatening complication of medical illness. It’s amazing that health care professionals and society in general still seem to struggle to understand this neuropsychiatric condition in terms of its pathophysiology, clinical presentations, and most importantly, prevention.

Every single day, in my role as a psychiatric consultant, I see patients suffering from delirium. Opinions differ about a psychiatrist’s role, but I think my main contribution is to help internists and surgeons identify delirium as quickly as possible in order to propel the health care team away from the notion that it’s a primary psychiatric problem and toward the goal of treating the underlying medical causes of this syndrome which mimics so many mental disorders.

A recent report highlighted the elevated mortality rate of delirious patients, yet omitted the efforts of major groups of researchers and clinicians working to understand delirium better in order to reduce its prevalence.

Over the years I’ve highlighted what I think is the absurdity of calling a psychiatrist first when delirium is an obvious problem when a patient’s mental status abruptly changes in the context of severe medical illness. I teach medical students that delirium should be viewed as a medical emergency, in the hope that the next generation of doctors will improve the recognition and management of this dangerous condition, which can lead to dementia, death, and disability.

There are important groups working diligently on the problem of delirium, including the American Delirium Society and the European Delirium Association to name only two. The latter has a compelling video of a first-person interview of a patient who suffered delirium. And you can also see the video of a ICU delirium survivor’s description of his harrowing experience with delirium and consequent development of PTSD.

The research on delirium continues and probably doesn’t get the press attention it deserves.

All that said, there is still a lot of work to do in order to get a better handle on the pathophysiology of delirium, find reliable pre-operative biomarkers to allow better prediction of which patients are at risk, and preventing this dangerous neuropsychiatric complication of medical illness.

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