Psychiatric Approach to Delirium

Delirium is an acute change in a person’s sensorium (the perception of one’s environment or understanding of one’s situation). It can include confusion about their orientation, cognition or mental thinking.

With hyperactive delirium, a patient can become aggressive, violent and agitated with those around them. A patient experiencing delirium can have hallucinations and hear things, they can become paranoid, and they are overall confused. A family or non-psychiatric medical staff might be concerned that the patient is experiencing something like schizophrenia.

Hyperactive delirium symptoms in patients:

Waxing and waning —it comes and goes

Issues with concentration

Pulling out medical lines

Yelling profanities

Throwing things

Agitated

Responding to things in the room that aren’t there

Not acting like themselves

Hypoactive delirium is much more common than hyperactive delirium (based on research studies), but it is often missed because the presentation is much less dramatic. People with hypoactive delirium are confused and disoriented, but they are not expressing their confusion verbally or physically.

Hypoactive delirium symptoms:

Slower movement

Softer speech

Slower responses

Withdrawn

Not eating as much

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