Medical history (history of illness) represents an important component in the diagnosis of delirium. Family history
- What is the general health of your family members?
- Are there any diseases in your family that are common?
- Isolation, change of location, losses or grief?
Social history
- What is your profession?
Current medical history/systemic history (somatic and psychological complaints).
- What symptoms have you noticed?
- Impaired perception, fluctuates over hours/days.
- Attention deficit
- Restriction of perception, speech, etc. to varying degrees.
- Altered sleep-wake rhythm
- Hallucinations, delusions
- Affective disorders (disorders characterized primarily by a clinically significant change in mood, e.g., depression or mania/severe inner restlessness and drive).
- Have you noticed any changes in cognition, speech, etc.?
- Was/is the affected person rather withdrawn and apathetic?
- Or rather agitated and restless?
- Acute onset of the disorder?
- How long have these symptoms been present?
- Have you noticed any other symptoms?
Vegetative anamnesis incl. nutritional anamnesis.
- Do you smoke? If yes, how many cigarettes, cigars or pipes per day?
- Do you drink alcohol more often? If yes, what drink(s) and how many glasses of it per day?
- Do you use drugs? If yes, which drugs (ecstasy, GHB (“liquid ecstasy”), cocaine, LSD, opiates, PCP (“angel dust”)) and how often per day or per week?
Self-history incl. medication history.
- Pre-existing conditions (neurological diseases; depression).
- Operations
- Radiotherapy
- Vaccination status
- Allergies
Medication history (modified according to)
- ACE inhibitor
- Alpha blocker
- Analgesics:
- Acetylsalicylic acid (delirogenic only in high doses).
- Nonsteroidal anti-inflammatory drugs (NSAIDs) can cause delirium
- Opiates (high-risk substances when starting and also when discontinuing).
- Antiarrhythmics
- Antibiotics
- Quinolones/fluoroquinolones/gyrase inhibitors (ciprofloxacin, moxifloxacin, nalidixic acid, norfloxacin, lomefloxacin, levofloxacin, ofloxacin).
- SS-lactam antibiotics
- Cephalosporins
- Macrolides
- Penicillin in high doses
- Anticholinergics
- Antidepressants:
- Serotonin–norepinephrine reuptake inhibitors (SSNRIs).
- Serotonin reuptake inhibitor (SSRI).
- Tricyclic antidepressants
- Antidiabetic agents, oral – which induce hypoglycemia.
- Antiepileptic drugs, including phenytoin.
- Antihypertensives (antihypertensive drugs) – alpha-receptor blockers (CNS attenuation can be enhanced by alcohol, antipsychotics, antihistamines, benzodiazepines and opiates).
- Anticonvulsants (antiepileptics) – adverse drug reaction usually due to overdose; Cave! Hyponatremia under carbamazepine and oxcarbazepine.
- Antipsychotics (neuroleptics) – preparations with anticholinergic potency (e.g., clozapine and olanzapine) are more delirogenic
- Antivertiginosa
- Beta blockers
- Benzodiazepines (3-fold risk of delirium) – withdrawal may cause delirium
- Calcium antagonists
- Narcotics (BtM)
- Digitalesglycosides, e.g., digitoxin, digoxin.
- Diuretics (especially thiazides).
- Hormones
- Corticosteroids, systemic
- Steroids, systemic (delirogenic risk is dose-dependent).
- Ketamine (narcotic)
- Lithium
- MAO inhibitors
- Neuroleptics (D2 antagonists and serotonin–dopamine antagonists) (4.5-fold risk of delirium)
- Nonsteroidal anti-inflammatory drugs (NSAIDs).
- Nitrates and other vasodilators.
- Lidocaine
- Opiates
- Opioids (2.5 times the risk of delirium)
- Parasympatholytics
- Parkinson’s drugs:
- Amantadine and dopamine agonists (e.g., bromocryptine) (higher risk).
- Cathechol-O-methyltransferase (COMT) inhibitors (low risk).
- Levodopa (lowest delirogenic potency).
- Herbal agents, unspecified.
- Psychoactive medications (including antipsychotics, antidepressants, tranquilizers).
- Sedating H1 antihistamines (also known as antiemetics).
- Theophylline
Environmental history including intoxications.
- Alcohol intoxication (alcohol poisoning)
- Alcohol withdrawal
- Toxins such as carbon monoxide, ethylene glycol (antifreeze), pesticides (pesticides).