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Clinical features

Last reviewed dd mmm yyyy. Last edited dd mmm yyyy

Authoring team

Possible clinical features of delirium include:

  • in a hospital
  • hypoactive form
    • most common form seen in older individuals which often goes unrecognised
    • makes a person withdrawn, quiet, sleepy with additional features such as
      • unawareness
      • decreased alertness
      • sparse or slow speech
      • lethargy
      • reduced/slowed movements
      • reduced appetite
      • apathy
  • hyperactive form
    • makes a person restless, agitated, aggressive along with:
      • increased confusion
      • hallucinations (visual or auditory)/delusions
      • sleep disturbance
      • fast or loud speech
      • irritability
      • combativeness
      • impatience
      • uncooperativeness
      • euphoria
      • anger
      • easy startling
      • distractibility
  • mixed form
    • most commonly diagnosed subtype
    • patient may present with features of hyper and hypoactive forms
  • in the community
    • an increased risk of delirium is seen in recently discharged patients sent directly to their homes
    • they may experience - loss of behaviour control, mood fluctuations, episodes of frank psychosis, or agitation
  • in long-term care facility
    • patients usually have hypoactive form of delirium in this setting
  • nearing death
    • in the hospice or palliative care setting, patients commonly have hypoactive delirium
    • usually misdiagnosed in these terminally ill patients as depression or severe fatigue (1)

NICE have outlined a set of indicators of delirium: at presentation (2)

  • at presentation, assess people at risk for recent (within hours or days) changes or fluctuations in behaviour. These may be reported by the person at risk, or a carer or relative. Be particularly vigilant for behaviour indicating hypoactive delirium (marked *). These behaviour changes may affect:
    • cognitive function: for example, worsened concentration*, slow responses*, confusion
    • perception: for example, visual or auditory hallucinations
    • physical function: for example, reduced mobility*, reduced movement*, restlessness, agitation, changes in appetite*, sleep disturbance
    • social behaviour: for example, lack of cooperation with reasonable requests, withdrawal*, or alterations in communication, mood and/or attitude

NICE suggest that if any of these behaviour changes are present, a healthcare professional who is trained and competent in diagnosing delirium should carry out a clinical assessment to confirm the diagnosis.

Reference:


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