Delirium

Delir (Latin delirare = to be insane or de lira ire = to go off the rails or track; ICD-10-GM F05.-: Delirium not due to alcohol or other psychotropic substances; ICD-10-GM F10.4: Mental and behavioral disorders due to alcohol, withdrawal syndrome with delirium; ICD-11-GM F10.4: Mental and behavioral disorders due to opioids, withdrawal syndrome with delirium; ICD-10-GM F12. 4: Mental and behavioral disorders due to cannabinoids, withdrawal syndrome with delirium; ICD-10-GM F13.4: Mental and behavioral disorders due to sedatives or hypnotics, withdrawal syndrome with delirium; ICD-10-GM F14. 4: Mental and behavioral disorders due to cocaine, withdrawal syndrome with delirium; ICD-10-GM F15.4: Mental and behavioral disorders due to other stimulants, including caffeine, withdrawal syndrome with delirium; ICD-10-GM F16.4: Mental and behavioral disorders due to hallucinogens, withdrawal syndrome with delirium; ICD-10-GM F17.4: Mental and behavioral disorders due to tobacco, withdrawal syndrome with delirium; ICD-10-GM F18. 4: Mental and behavioral disorders due to volatile solvents, withdrawal syndrome with delirium; ICD-10-GM F19.0: Mental and behavioral disorders due to multiple substance use and use of other psychotropic substances, Acute intoxication [acute intoxication]; ICD-10-GM F19.1: Mental and behavioral disorders due to multiple substance use and use of other psychotropic substances, Harmful use; ICD-10-GM F19. 2: Mental and behavioral disorders caused by multiple substance use and use of other psychotropic substances, Dependence syndrome; ICD-10-GM F19.3: Mental and behavioral disorders caused by multiple substance use and use of other psychotropic substances, Withdrawal syndrome; ICD-10-GM F19.4: Mental and behavioral disorders caused by multiple substance use and use of other psychotropic substances, Withdrawal syndrome with delirium) refers to an acute state of confusion. There is a relatively acute decrease in cognition. Delir can be triggered by many different illnesses as well as by various substances such as alcohol or drugs. Delir is a relatively common condition, occurring in up to over 80% of hospital patients, depending on the cause and clientele. In intensive care patients, it is the most common acute psychiatric illness. However, in up to one-third of those affected, the diagnosis of delirium is not recognized. In the outpatient setting, delirium occurs primarily in nursing facilities and in prefinal patients. One can distinguish the following forms of delirium according to the ICD-10-GM code:

  • Delirium without dementia (ICD-10-GM F05.0).
  • Delirium with dementia (ICD-10-GM F05.1)
  • Other forms of delirium (ICD-10-GM F05.8)
    • Delirium with mixed etiology
    • Postoperative delir
  • Delirium unspecified (ICD-10-GM F05.9)
  • Mental and behavioral disorders due to various substances with withdrawal syndrome with delirium (ICD-10-GM F10.4-ICD-10-GMF19.4)

Hypoactive delir can be distinguished from hyperactive delir:

  • Hypoactive delirium – characterized by lack of movement, lethargy, somnolence (affected person is sleepy but responds to external stimuli such as responding) and little spontaneous contact; especially in opiate intoxication; in elderly patients this is the more common form
  • Hyperactive delirium – characterized by psychomotor agitation to agitation, agitation (morbid restlessness), increased irritability (increased irritability), anxiety, hallucinations, and vegetative signs; especially in alcohol withdrawal

Delirium can last from a few hours to months. In the operational field, a distinction must be made between:

Delirium tremens (alcohol withdrawal delirium) can be classified as a special form:

Sex ratio: men are more likely to experience delirium in old age due to increased alcohol abuse (alcohol misuse). Frequency peak: of 65-year-olds, about 20% present with delirium on hospital admission. The prevalence (disease incidence) ranges from 14-56% in hospitalized patients (in Germany). Course and prognosis: The course and prognosis depend on the cause of the delirium.With increasing age, delirium is associated with significantly higher mortality (number of deaths, relative to the number in the population of interest) of 10-65% (compared with non-delirious patients of the same age).