An Interdisciplinary Reappraisal of Delirium and Proposed Subtypes

Mark A Oldham, Arjen J C Slooter, E Wesley Ely, Cathy Crone, José R Maldonado, Lisa J Rosenthal

Onderzoeksoutput: Articlepeer review

3 Citaten (Scopus)

Samenvatting

An interdisciplinary plenary session entitled "Rethinking and Rehashing Delirium" was held during the 2021 Annual Meeting of the Academy of Consultation-Liaison Psychiatry to facilitate dialog on the prevalent approach to delirium. Panel members included a psychiatrist, neurointensivist, and critical care specialist, and attendee comments were solicited with the goal of developing a statement. Discussion was focused on a reappraisal of delirium and, in particular, its disparate terminology and history in relation to acute encephalopathy. The authors endorse a recent joint position statement that describes acute encephalopathy as a rapidly evolving (<4 weeks) pathobiological brain process that presents as subsyndromal delirium, delirium, or coma and suggest the following points of refinement: (1) to suggest that "delirium disorder" describe the diagnostic construct including its syndrome, precipitant(s), and unique pathophysiology; (2) to restrict the term "delirium" to describing the clinical syndrome encountered at the bedside; (3) to clarify that the disfavored term "altered mental status" may occasionally be an appropriate preliminary designation where the diagnosis cannot yet be specified further; and (4) to provide rationale for rejecting the terms acute brain injury, failure, or dysfunction. The final common pathway of delirium appears to involve higher-level brain network dysfunction, but there are many insults that can disrupt functional connectivity. We propose that future delirium classification systems should seek to characterize the unique pathophysiological disturbances ("endotypes") that underlie delirium and delirium's individual neuropsychiatric symptoms. We provide provisional means of classification in hopes that novel subtypes might lead to specific intervention to improve patient experience and outcomes. This paper concludes by considering future directions for the field. Key areas of opportunity include interdisciplinary initiatives to harmonize efforts across specialties and settings, enhance underrepresented groups in research, integration of delirium and encephalopathy in coding, development of relevant quality and safety measures, and exploration of opportunities for translational science.

Originele taal-2English
Pagina's (van-tot)248-261
Aantal pagina's14
TijdschriftJournal of the Academy of Consultation-Liaison Psychiatry
Volume64
Nummer van het tijdschrift3
Vroegere onlinedatum14 jul 2022
DOI's
StatusPublished - 1 mei 2023

Bibliografische nota

Funding Information:
This review is derived from an interdisciplinary panel discussion entitled “Rethinking and Rehashing Delirium” held during the 2021 Annual Meeting of the Academy of Consultation-Liaison Psychiatry. Funding: This article did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Publisher Copyright:
© 2022 Academy of Consultation-Liaison Psychiatry

Copyright:
Copyright 2023 Elsevier B.V., All rights reserved.

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