Delirium and the consultation setting

Abstract

Delirium, characterized by disturbance of cognition, attention, sleep wake cycle and psychomotor behaviour is a frequent, and frequently missed disorder amongst medically ill patients. It is associated with high morbidity and mortality. Patients with HIV infection are at particular risk for the development of delirium. Causative factors include the direct effects of HIV disease, the effects of opportunistic conditions, side effects of prescribed medications and co-morbid alcohol and drug use. Diagnosis may be difficult, especially if comorbid dementia is present. When psychiatric symptoms are prominent, delirium must be distinguished from the various psychiatric disorders which may accompany HIV infection. Management must include treatment of the cause(s) of the delirium coincident with strategies to relieve the patient's subjective distress and behavioural disturbance.