BMJ  2007;334 (21 April), doi:10.1136/bmj.39206.656447.3A

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Delirium, opioid regulation, and pathological gambling

The first 150 words of the full text of this article appear below.

Delirium is common in elderly patients in emergency and inpatient settings. It is often caused by hospitalization and its attendant procedures. John Young and Sharon Inouye review the causes, diagnosis, and treatment of delirium, and distinguish it from dementia (doi: 10.1136/bmj.39169.706574.AD).

Even in our hi-tech world, the diagnosis of delirium remains a clinical one. Medical history is crucial—has there been a recent decline in cognitive function? Fluctuating awareness, impairment of memory, and disorganized thinking are commonly seen. Precipitants may include infections, drugs, surgery, or myocardial infarction.

Differentiating delirium and dementia is often difficult. They are probably related both clinically and pathophysiologically. While the key is obtaining a history of the patient's clinical course from a family member or caregiver, in most cases it makes sense to consider all older people presenting with confusion to have delirium until proven otherwise.

Another difficult problem for doctors can be the proper prescription . . . [Full text of this article]

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