Talk:Delirium

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This article is the subject of a course assignment, between Oct 28, 2019 and November 25 2019. Further details are available on the course page. Assigned student editor(s): 14kl3, Abby.christi, Judypl2023

Wiki Education Foundation-supported course assignment

This article was the subject of a Wiki Education Foundation-supported course assignment, between 4 March 2019 and 29 March 2019. Further details are available on the course page. Student editor(s): Alulu00. Peer reviewers: Thayermartin.

Above undated message substituted from Template:Dashboard.wikiedu.org assignment by PrimeBOT (talk) 19:15, 16 January 2022 (UTC)

Redirected from "cognitive dysfunction" and "cognitive impairment"

Cognitive dysfunction or impairment needn't be severe (which delirium is stated as being in the intro, although this is contradicted later) and can have gradual onset, whereas this article insists on acute onset. There's obvious overlap in some symptoms, maybe occassionally treatment but I have never heard the type of impairments commonly described as "brain fog" for instance, described as delirium, but perhaps I'm wrong. I think either the delirium article needs to be broadened or more likely there should be a separate article for non-acute generally less severe cognitive dysfunction and/or impairment. Speaking as a lay person the impression I get is that delirium is more often associated with generally severe hallucination-inducing disorders such as high fevers whereas cognitive impairment is more often some degree of attentional or intellectual disability such as some loss of circumstantial problem solving (which could be severe but perhaps more commonly isn't). Vespadrun (talk) 20:52, 28 October 2012 (UTC)

"Acute" is defined as "hours to days, but not months or years." Any organic decrease in mentation that develops over years is called "dementia" not delirium. Delirium doesn't have to be severe, and I've corrected that. It can be a "brain fog" like state, and often is. The lay definition that suggests halucination is not correct (or at least, not complete). The medical definition includes all recent-onset cognitive impairments that have an organic cause. Thus, the total spectrum of cognitive impairment is a much broader thing that includes not only delirium, but also many other things that aren't delirium, such as learning and intellectual disabilities (what used to be called mental retardation), various psychiatric problems, effects of dementia, and so on. SBHarris 02:27, 29 October 2012 (UTC)

Proposed major revision

On behalf of the European Delirium Association and the American Delirium Society, we'd like to contribute to a major revision of this article. None of us are experienced Wikipedia editors, but we hope it will be a worthwhile endeavour given that this is designated 'high importance' but class-C article.

Proposed addition

My plan for editing the article on delirium is adding a section under prevention that outlines the goals of the HELP organization in the prevention of delirium and highlights some of the research that they have done. Ariellarose19 (talk) 21:18, 15 November 2023 (UTC) Proposed article structure

Initial (including clinical importance of delirium)

Definition

• DSM v ICD
• Why delirium is the preferred term
• Delirium on the spectrum of acute brain dysfunction

Clinical importance by setting and predictors of outcomes

• ICU
• Hospital
• Post-operative delirium
• Institutional care
• Palliative care

Signs and symptoms (Rewritten with contribution from David Meagher, 10.12.12)

• Inattention and associated cognitive deficits (10.12.12)
• Higher level thinking processes (10.12.12)
• Circadian disruption (10.12.12)
• Prodrome
• Subsyndromal delirium
• Persistent delirium (added 06.12.12)
• Acquired dementia (added 06.12.12)

Pathophysiology

• Animal models of delirium (added 12.12.12)
• Insights from clinical studies (CSF, MRI, EEG) (added 31.01.13)

Causes (added 8.2.13)

• Discussion of the inverse relationship between predisposing and precipitating factors (and the common causes), rather than the rather long list which is ultimately not very informative.

Prognosis (added 20.11.12)

• Mortality
• Institutionalisation
• Dementia
• Cost

Diagnosis in different care settings

• ICU (added 06.12.12)
• Hospital
• Institutional care

Prevention (covering the major RCTs)

• Pharmacological
• Non-pharmacological

Treatment (covering the major RCTs)

• Pharmacological
• Non-pharmacological

It's likely that we'll need some support as we do this, but we're keen to contribute to (and maintain) the article. The board members of the EDA and ADS number around 35 persons with a multidisciplinary background and experience in research, clinical practice and education, so I think we should be able to offer a balanced article.

Please leave any suggestions and advice here. Thanks and best wishes, Dhj davis (talk) 07:03, 13 November 2012 (UTC)

I am aware of the project and am very pleased that the EDA recognises the need of a high-quality Wikipedia article on the condition. I will post a message on WT:MED so other editors can watchlist this article and provide support when needed. I agree with the basic structure, which is aligned broadly with WP:MEDMOS. However, I would not use the "classification" section to explain why delirium is clinically important - this is something better done in the introduction and in the prognosis sections. As for "delirium is special settings", perhaps this is best integrated with "signs and symptoms", "diagnosis" and "treatment" insofar possible. JFW | T@lk 08:24, 13 November 2012 (UTC)

Thanks JFW. We've taken out the epidemiology section and defined the different settings earlier on, these distinctions can then be referred to in the later sections as you suggest. I'm not sure it's correct procedure to edit back on a talk page, but I thought it would be easier than reproducing the whole outline again. Hope that's OK. Dhj davis (talk) 15:39, 13 November 2012 (UTC)

I've added a section (Adverse Outcomes) to test the process a bit, very happy for comments. I know I haven't done the citations correctly, they seem to repeat themselves, but I'll look into this and learn how to fix it. I'm mainly interested in whether the addition is well-received. I should also point out that I'm an author on one of the (peer-reviewed) articles cited, but I hope that doesn't contravene NPOV. Dhj davis (talk) 19:25, 20 November 2012 (UTC)

Looks good, but please avoid primary sources in favour of reviews and textbooks. Very recent studies do not necessarily need a mention. JFW | T@lk 00:22, 21 November 2012 (UTC)

Thanks JFW, I'll think about the sources. The difficulty is that recent (uncontroversial) studies make the article up to date, but they haven't necessarily filtered through to reviews and textbooks yet. What do you think about actually using 'Uptodate' (the website) as a secondary source?Dhj davis (talk) 12:07, 23 November 2012 (UTC)

Bit more to be added today on ICU delirium, from Wes Ely. Dhj davis (talk) 10:20, 6 December 2012 (UTC)

And some reorganisation of the phenomenology section from David Meagher (more citations to be added)Dhj davis (talk) 22:06, 10 December 2012 (UTC)

I support using UpToDate. Thanks. Sorry I haven't been around to help more. Biosthmors (talk) 22:21, 10 December 2012 (UTC)

Applying WP:MEDREV with wise editorial judgement is another option. Biosthmors (talk) 22:23, 10 December 2012 (UTC)

New section on pathophysiology added. I think we'll continue to add some more sections and when all this is complete, I think we could use some help in editing for overall tone and perhaps cutting down the length. One major overhaul I think is necessary is the Causes section. Delirium is a sensitive marker of illness, so it's very non-specific, i.e. probably anything can cause delirium. I think the section needs a discussion on how predisposing factors interact with precipitating factors, perhaps reviewing just the most common processes, e.g. drugs, hypoxia, infection. Thank you again for your guidance throughout. Dhj davis (talk) 10:41, 12 December 2012 (UTC)

Some further additions on clinical pathophysiology studies, summarising information from 3 systematic reviews. Where additional studies have been referred to since the publication of the SRs, these were (systematically) identified by re-running the searches detailed in the original SRs.Dhj davis (talk) 00:06, 1 February 2013 (UTC)

Experienced editors interested in supporting new editors

Per the proposed revision above, new editors are welcome to contact any editor listed below on their talk page for specific questions about how to edit Wikipedia. Also, the "Teahouse" is designed to be a welcoming place, and the links at {{MedWelcome-reg}} are useful because they contain good links and ways to contact other editors for help.

• Biosthmors (talk · contribs)
• Jfdwolff (talk · contribs)

Comments

• Can't we name "Adverse outcomes after delirium" just "Prognosis" per WP:MEDMOS?

yep. done Casliber (talk · contribs) 06:43, 21 November 2012 (UTC)

• If it is causative, let's specify a mechanism. If it's just a consistently observed association, let's just state that it is associated?

not so easy. can be very difficult in hospital inpatients with complex medical problems to deifinitly assign causes. Casliber (talk · contribs) 06:43, 21 November 2012 (UTC)

These are consistently observed associations from prospective studies. These can't on their own make causative claims. Dhj davis (talk) 12:07, 23 November 2012 (UTC)

• "It" is "long-term poor outcomes", which is too vague.
• "Only studies that looked at the independent effect of delirium were included". How can we be certain that methodologically they corrected for all confounding variables? That overstates the source, most likely.

This was a rigorously conducted systematic review and an inclusion criterion was that all associations were adjusted for age, sex, etc, but *also* that predisposing factors (e.g. baseline frailty, dementia) and precipitating factors (e.g. illness severity, physiological and metabolic parameters) were adjusted for. Of course, this is a meta-analysis of observational data, so there is always a risk of residual confounding, but it's the best estimate we have. Dhj davis (talk) 12:07, 23 November 2012 (UTC)

• We shouldn't be describing studies this much "(i.e., after accounting for other associations with poor outcomes, for example co-morbidity or illness severity)." Encyclopedias just state the facts. Studies have limitations. So then we just state the facts as best we can given those limitations.

Thanks, that was what I was trying to do - show that the systematic review had considered these limitations and accounted for them. (see below about my WP:MEDRS question). Dhj davis (talk) 12:07, 23 November 2012 (UTC)

• "A systematic review collected all studies that followed-up this population for at least three months after discharge from hospital." Irrelevant. Of course we should be using WP:MEDRS. Let's just state the facts.

For my clarification, is the spirit of WP:MEDRS that because this is a systematic review in JAMA (i.e. reliable), it's not necessary to add detail qualifying the nature of the study (methods etc)? I'll take that out. On the other hand, any tips on how to balance this with overstating the source (as above)? Dhj davis (talk) 12:07, 23 November 2012 (UTC)

A late reply but no, it's not necessary to qualify the nature of the study. Biosthmors (talk) 20:27, 18 January 2013 (UTC)

• "One study has investigated these same associations in the general population, and found consistent results". How can we be certain this isn't cherry-picked? This is why we use reviews and follow WP:MEDREV

Thanks for pointing this out - it does read like it's cherry picked, but in fact it's the *only* study of delirium outcomes in an unselected, general population. It's the study I'm an author on, but I wouldn't want you to think that compromises WP:NPOV. It's not a controversial finding, and strengthens the results of the systematic review in the population of hospital patients. The reason for it being mentioned it that it overcomes some of the biases that the systematic review is vulnerable to (because that only studies persons in hospital once delirium has developed, without the advantage of prospective, pre-delirium cognitive assessments (i.e. a 'before' and 'after' picture).Dhj davis (talk) 12:07, 23 November 2012 (UTC)

• Those are my comments just for the first paragraph of that section. I can't say I like anything it says. I'm glad you're here to help out!
• The rest of the section probably doesn't need any level three subheadings (such as ===Death===) which should probably just be mortality/mortality rate in prose, I imagine.
• Costs should go under Society and culture per WP:MEDMOS. If enough data exists, an Economics section can stand alone. Biosthmors (talk) 06:14, 21 November 2012 (UTC)

Addition 6 Dec

The following sentence was added:

“ It is not as important which tool is used as that the patient gets monitored. Without using one of these tools, 75% of ICU delirium is missed by the practicing team, which leaves the patient without any likely active interventions to help reduce the duration of his/her delirium. ”

This requires a source, particularly because a numerical claim is made, and gives the suggestion of passing judgement. JFW | T@lk 20:29, 6 December 2012 (UTC)

Thanks JFD. The primary study where the 75% figure comes from is this one: PMID 21514176, but I've gone for a secondary source that also mentions it. Dhj davis (talk) 21:26, 6 December 2012 (UTC)

Fantastic. JFW | T@lk 23:21, 6 December 2012 (UTC)

Drugs versus Medication

In the section Delirium#Causes, there are separate sub-sections for "Medication" and "Drugs". Should these not be combined, particularly as medication is also referred to as a pharmaceutical drug? Also, the sub-section "Substance withdrawal" should be merged into "Drugs" (where it is already discussed). I don't want to do this myself as this is not my area of expertise. HairyWombat 23:15, 21 January 2013 (UTC)

Agree, and we will address this when the 'Causes' section is overhauled. Dhj davis (talk) 00:06, 1 February 2013 (UTC)

Just started the causes section, but called away before adding references etc. Will return to this shortly. Dhj davis (talk) 17:06, 8 February 2013 (UTC)

Admittedly more to do with the references, but I've run out of time for now....Dhj davis (talk) 20:31, 8 February 2013 (UTC)

Thanks for your edits! Biosthmors (talk) 20:51, 8 February 2013 (UTC)

The list looks good. Could I recommend that nested lists of causes are converted to tables? See WP:EMBED. You could grab the code from hypopituitarism or pneumothorax where I used this approach. JFW | T@lk 23:50, 9 February 2013 (UTC)

Good Article aspirations

Just to point out that Delirium is on this list: Wikipedia:WikiProject Medicine/Good article goals for 2013, and that the European Delirium Association and the American Delirium Society will be helping with edits here over the next few months.Dhj davis (talk) 00:06, 1 February 2013 (UTC)

Emergency medicine

Delirium in the Emergency Department - doi:10.1136/emermed-2011-200586 JFW | T@lk 20:48, 21 March 2013 (UTC)

Delirium should be contrasted with dementia

Hence dementia is "chronic" loss of cognition, whereas delirium is "acute" loss of cognition. PS: Delirium and confusion are distinct (from a psychiatric perspective)-since confusion occurs to everyone, and delirium - does not. 129.180.175.45 (talk) 09:05, 25 October 2013 (UTC)

I've read through it more thoroughly, and it just is really badly written. For example, in the opening paragraph, essentially, it is NECESSARY to refer to the DSM diagnostic criteria. Not just what "somebody thinks" 129.180.175.45 (talk) 23:29, 25 October 2013 (UTC)

Merger proposal

The following discussion is closed. Please do not modify it. Subsequent comments should be made on the appropriate discussion page. No further edits should be made to this discussion.

---

See also: Talk:Mental confusion § Tagged for expert opinion needed

Received request to merge the Mental confusion (edit | talk | history | protect | delete | links | watch | logs | views) article into the Delirium (edit | talk | history | protect | delete | links | watch | logs | views) article on 14 November 2013. Discuss it here. GenQuest ^{"Talk to Me"} 02:21, 15 November 2013 (UTC)

• Disagree, I believe these have different social and cultural connotations and shouldn't be merged. --LT910001 (talk) 03:02, 16 November 2013 (UTC)
• Disagree Indeed they overlap but are different. A person with dementia, for example, may have permanent mental confusion, but is not delirious. And some set of delirious people are not actually confused (disoriented, etc) but simply have an inability to focus (like temporary ADD, or even ADHD). And of course some delirious people are simply drowsy, but again not confused. Anybody who hasn't slept in 48 hours or more will be clinically delirious. How confused they are, depends on the person. SBHarris 03:01, 23 December 2013 (UTC)
• Disagree for reasons stated. JFW | T@lk 14:52, 23 December 2013 (UTC)

The discussion above is closed. Please do not modify it. Subsequent comments should be made on the appropriate discussion page. No further edits should be made to this discussion.

Age as predictor

The article was changed by QuintBy (talk · contribs):

“ It is a syndrome which occurs more frequently in people in their later years although it is unclear whether it is in fact a function of age per se or whether it is simply a reflection of the fact that older people tend to develop critical illness more frequently. ”

I would like to see the source before this sentence can be allowed to stand. In daily practice it is exceedingly common for elderly people to develop delirium in the context of really very mild acute illness, while in younger people you need to be critically ill before that happens. For the moment I've taken out the entire sentence. JFW | T@lk 07:35, 19 January 2014 (UTC)

Thank you JFW and I agree with you! However, since there seems to be no controversy about "It is a syndrome which occurs more frequently in people in their later years" I put that sentence back in. Lova Falk talk 19:55, 19 January 2014 (UTC)

I don't mind having it put back, but QuintBy seemed to be challenging it. JFW | T@lk 20:18, 19 January 2014 (UTC)

I cannot see that QuintBy challenges the higher prevalence, which is exactly what we say in this sentence. Lova Falk talk 20:34, 19 January 2014 (UTC)

The obvious conclusion which the original author intended to convey was that older people are more susceptible to ICU delirium. What I suggested is that it is "unclear" whether the more frequent occurrence in older people is a function of their being old or whether it is simply a function of their being present in ICUs more often. If there is in fact research which establishes that what I called "unclear" is in fact "clear" then I believe it is incumbent upon the reverter to cite a reference which reached that conclusion. I don't think there is any such research. On the other hand, the October 2 (or 3), 2013 edition of the New England Journal of Medicine includes a research paper which either explicitly or implicitly states that ICU delirium occurs at approximately the same rate in all age groups, genders, etc. Unfortunately, NEJM current maintains an embargo on this article. I will probably reinstate with general reference to the article. But before I do I want to give the reverter a chance to include the research he/she claims makes it "clear".QuintBy (talk) 22:16, 19 January 2014 (UTC)

QuintBy, when you add text you also need to add a source for your text - even when stating something is unclear. It is not up to the reverter to find a source that supports the revert, it is up to the author of the added text to find a source that supports the addition. Lova Falk talk 08:53, 20 January 2014 (UTC)

We need a secondary source for your claim, as outlined in WP:MEDRS. It bears remembering that delirium is exceedingly common in hospitalised (and even community-dwelling) people, predominantly the elderly. ICU cares for only a small proportion of those people. You might be right that on ICU everyone is so unwell as to carry a roughly equivalent risk of delirium, but this does not apply to other groups. JFW | T@lk 20:29, 20 January 2014 (UTC)

You will note that 'ICU delirium' redirects to "Delirium", meaning that the article is supposed to refer to BOTH conditions. I believe I was quite careful to note that what I was referring to is ICU delirium. It is indeed a shame that some misguided editor decided that everything to do with delirium should be contained in one article, but there it is. I can certainly see how someone who works only in a nursing home environment would come to believe that only older people develop delirium. There are, after all, no younger patients there with rare exception. — Preceding unsigned comment added by QuintBy (talk • contribs) 20:43, 22 January 2014 (UTC)

(←) QuintBy Sorry, I cannot let that go unchallenged. Your edit suggested that age was not a predictor of delirium risk,[1] which is amply contradicted both by experience and by data. You noted the distinction only in your edit summary, which is not visible to readers who are simply perusing the article.

I don't think the decision to discuss all forms of delirium in a single article is "misguided", nor was it the decision of a single editor. Much of what we know about delirium in the frail elderly comes from studies in ICU delirium, and the pathophysiology is one and the same. The management strategies, too, are very similar (e.g. reorientation, low-stimulus nursing, pharmacotherapy). JFW | T@lk 21:39, 22 January 2014 (UTC)

What the most recent research in the area of ICU delirium has indicated is that "what we know about (ICU) delirium" is mainly wrong because it HAS been based upon observations by gerontologists who didn't have a clue that ICU delirium occurred in younger patients. QuintBy (talk) 05:43, 27 July 2014 (UTC)

EEG

doi:10.1186/s13054-014-0674-y - EEG may help prognosticate. JFW | T@lk 20:37, 13 December 2014 (UTC)

Critical care delirium - systematic review

doi:10.1186/s13054-015-0886-9 JFW | T@lk 12:12, 23 April 2015 (UTC)

Video

It seems that the video explanation, which is mostly text-based, is an unferenced and unpublished synthesis, which is both unhelpful (in the presence of the text), unreferenced (breaching WP), and promotional (advertising and self-aggrandizement at the end). Perhaps I'm being too harsh, as I'm sure that the original creator was trying to be helpful. Nevertheless, given the problems, delete? Klbrain (talk) 22:33, 13 February 2017 (UTC)

User:Doc James has removed the Template:Synthesis without attempting discussion here. The edit comment has "contains refs", but I can see no evidence to support this. There is a link to open.osmosis.org, but this is the web publisher and isn't a source for the content. So, I've reversed the edit until there is evidence of referencing or another argument made. Klbrain (talk) 14:03, 16 March 2017 (UTC)

Created by known medical experts. They are working to add references. Initially missed the discussion here. Thanks for pinging me. Doc James (talk · contribs · email) 04:03, 18 March 2017 (UTC)

Refs been added[2]Doc James (talk · contribs · email) 15:08, 21 March 2017 (UTC)

JAMA

Review doi:10.1001/jama.2017.12067 JFW | T@lk 18:48, 26 September 2017 (UTC)

Work Plan for Proposed Changes - Mar 2019

Hello everyone, I am a senior medical student in UCSF's Wikiproject-Medicine effort who hopes to further improve this article for a very important topic.

<> On initial analysis, some aspects for improvement are: lead discussion can be more concise, numerous redundancies/tautologies throughout article, complicated language and complex terminology that surpasses postgraduate-level training per Hemingwayapp, article has not been substantially updated in 2 years, can possibly incorporate some of the reviews suggested in the Talk discussions
<> Current strengths: very smartly structured, extensive discussion on pathophysiology+diagnosis, richly cited, the authors obviously care deeply about the topic
<> My main goals this month is to enhance readability for a more general audience and to incorporate newer literature RE: delirium.

By the following days, I will… (bolded = check in’s with team)
Fri 3/8: Submitted a work plan, present any obstacles to group
Mon 3/11: Get more familiar with the Wiki interface, post preliminary edits RE: readability, WP:MEDMOS
Wed 3/13: Assess currently cited references per WP:MEDRS
Fri 3/15: Gather further literature, Celebrate matching into residency (yay?)
Mon 3/18: Incorporate said literature, Reorganize sections/headers if needed
Wed 3/20: Peer review begins
Mon 3/25: Peer reviews complete, Respond to suggestions
Thu 3/28: Final Wrap Up

I will use the following questions to help guide me in this process: • Is each fact referenced with an appropriate, reliable reference? • Is everything in the article relevant to the article topic? Is there anything that distracted you? • Is the article neutral? Where does the information come from? Are these neutral sources? • Are there viewpoints that are overrepresented, or underrepresented? • Check a few citations. Do the links work? Is there any close paraphrasing or plagiarism in the article? • Is any information out of date? Is anything missing that could be added? • What resources do you intend to look up, and when? • How will you decide what things (signs, symptoms, side-effects, etc.) to explicitly include? To explicitly exclude? • How will you ensure you avoid "doctor-speak" and not use jargon? 

PLEASE: I would greatly appreciate any guidance during this journey. Thanks! — Preceding unsigned comment added by 199.241.201.84 (talk) 04:11, 8 March 2019 (UTC)

WikiMed Spring 2019 UCSF SOM Peer Review

Hello Wikipedians! I'm a fellow classmate of Alulu00, the medical student who has been editing this page recently. I am posting a peer review of his edits and some feedback on the article as a whole to help contribute to the development of this page. I focused on everything up to, and including, the pathophysiology section as requested by my peer.

Overall, I think you've done a fantastic job! I looked through the version of the article from before you started editing and you have contributed a lot. You have continued to use your work plan as a guide and I can see the influence of the questions you noted that you wanted to keep in mind. I've learned/refreshed a lot by reading through your article! You have Feel free to incorporate any or none of the feedback below!

• I'm not sure if this would work with delirium, but it might be nice to have an image or two in the article. Possibly in the pathophysiology section under neuropathology or neuroimaging? I'm really not sure though.

• Parenthetical use: I use parentheses constantly, so this is something I tend to pay attention to more. There are various places where it could be beneficial to remove the parentheses and break the sentence up into two sentence. For example:
  • "Delirium is caused by an acute organic process (i.e. a physically identifiable structural, functional, or chemical problem in the brain), which may arise from a disease process outside the brain that nonetheless affects the brain."
  • vs
  • "Delirium is caused by an acute organic process, which is a physically identifiable structural, functional, or chemical problem in the brain. This may arise from a disease process outside the brain that, nonetheless, affects the brain."

• Medical Language:
  • in the opening section, second paragraph, the word "mentation" is used, but for simplicity "mental function/status/etc..." might be clearer.

• Opening section, second paragraph: "In contrast, fluctuations in mentation due to changes in primarily psychiatric processes or diseases (e.g. schizophrenia, bipolar disorder) are, by definition, not termed 'delirium.'"
  • "psychiatric" is italicized, but might not need to be
  • instead of "are, by definition, not termed 'delirium'", simply "are, by definition, not delirium" or "do not, by definition, meet the criteria for delirium"

• Opening section, third paragraph: "sedative hypnotic" can probably be linked to its personal wikipedia page so people can look up what that means.

• Opening section, fourth paragraph: I always struggle with consecutive citations from the same source. Should each of those sentences have the [1] citation after it, or should it just be after the last sentence that is from that source?

• Signs and symptoms section: some of the symptoms listed don't have references. Is this list all from one source, or is it pieced together from various places? If its from one source, you could add a single citation to the end of the statement "The various features of delirium are further described below:" to cover everything below.

• Signs and symptoms section: definition for disorientation might be able to be streamlined slightly, possibly removing the first part and starting with "This describes..."

• Signs and symptoms section: definition for sleep changes has some redundancy in the two sentences and might be able to be combined: "In delirium, sleep disturbances typically involves fragmented sleep or even sleep-wake cycle reversal (i.e. active at night, sleeping during the day) and often precedes the onset of an episode."

• Signs and symptoms section, Persistent delirium subsection: the sentence "English medical writer Philip Barrow noted in 1583 that if delirium resolves, it may be followed by a 'loss of memory and reasoning power.'" doesn't have a citation, does it need one?

• Signs and symptoms section, Dementia and ICU subsection: the sentence
  • "...leaving many ICU survivors disabled and unable to go back to work and unable to serve effectively as the matriarchs and patriarchs of their families." can probably be shortened to "...leaving many ICU survivors permanently disabled." The addition of serving as matriarchs and patriarchs feels more like commentary and might not be the same for all patients.
  • The following sentence feels a bit long and might benefit from being shortened: "The implications of such an “acquired dementia-like illness” (note: the term here is being used in a circumstance in which not all patients continue to decline as some have persistent yet stable brain dysfunction and others with newly acquired brain problems can recover fully) are profound at the private level, dismantling the person’s life in very practical ways, such as impairing ability to find a car in a parking lot, complete shopping lists, or perform job-related tasks done previously for years."

• And/Or use: for simplicity of the article, there are a couple places where "and/or" is used that could probably just use "or" to convey the same message.

• Pathophysiology opening statement: "In general" can probably be removed.

• Pathophysiology section, CSF biomarker, Neuroimaging, Neurophysiology subsections: "A 20** systematic review..." readers might not know what a systematic review is, maybe "Research suggests that..." and then just cite the review to streamline it.

• Pathophysiology section, Neuropathology subsection: Two case studies and a retrospective study are mentioned. I know we are aiming to avoid primary sources, but I'm guessing this field of research is sparse and maybe we don't have great secondary resourced. Similar to the above comment, maybe just noting "Research shows" instead of mentioning the type of study for simplicity.

Sorry for all the notes. I tried to focus on sentence structure/grammar/etc (as you can tell) since I know you mentioned that cleaning up some of the language of the article would be a major focus. Again, you've done great work! I just got really into this article.

Thayermartin (talk) 05:44, 25 March 2019 (UTC)

                    >>>Thank you, Thaymartin, for your very helpful comments! I incorporated much of what you suggested, including some in reference to sections (Dementia in ICU survivors) that I didn't have the opportunity to go over yet. I kept the "and/or" in the Causes and some other sections because it was important for its meaning.

alulu00 (talk) 13:44, 27 March 2019 (UTC)

ok where to from here....

Right then, the article looks different to the last time I popped in here.....so aiming for some sort of stable version (GA being a good place to start with) Cas Liber (talk · contribs) 19:47, 5 July 2019 (UTC)

• On first impressions, the writing looks dense and needs to be less jargony without losing meaning.
• lead seems a little repetitive and statements in the wrong order (i.e. having how long it is before describing what it is)
• history of term can be expanded - see here. also relationship between layterm and medical term.

Queen's University Student Editing Initiative

Hello, We are a group of medical students from Queen's University. We are working to improve this article over the next month and will be posting our planned changes on this talk page. We look forward to working with the existing Wikipedia medical editing community to improve this article and share evidence. We welcome feedback and suggestions as we learn to edit.

Thank you! 14kl3 (talk) 20:18, 11 November 2019 (UTC)

Queen's University Student Editing Initiative: Proposed Changes

Hello,

We are proposing the following changes to this page on behalf of the Queen's University Student Editing Initiative:

Current Sentence A (Delirium#Treatment#Non-Pharmacologic Interventions): “Of note, severe agitation that endangers self or others may require physical restraints and professional supervision, but only as a last resort.”

Proposed Updated Sentence A: Restraints should rarely be used as an intervention for delirium. The use of restraints has been recognized as a risk factor for injury and aggravating symptoms, especially in elderly inpatients. The only cases where restraints should sparingly be used during delirium is in the protection of life-sustaining interventions, such as endotracheal tubes.

References

Current Sentence B (Delirium#Pathophysiology#Neuroimaging): “Despite similar heterogeneity in study design as described in an older 2008 analysis, a 2017 systematic review summarizes evidence of associated white matter disease (including cerebral atrophy, ventricular enlargement, and white matter lesions), abnormal changes in diffusion MRI characteristics and brain metabolites (reflecting microscopic tissue damage and non-neuronal nervous cell activity), and abnormal connectivity between different functional regions of the brain (consistent with interruptions in executive function, sensory processing, attention, emotional regulation, memory, and orientation as seen in delirium).”

Proposed Updated Sentence B: Edits (structural + clarification): Evidence for changes in structural and functional markers include: changes in white-matter integrity (white matter lesions), decreases in brain volume (likely as a result of tissue atrophy), abnormal functional connectivity of brain regions responsible for normal processing of executive function, sensory processing, attention, emotional regulation, memory, and orientation, differences in autoregulation of the vascular vessels in the brain, reduction in cerebral blood flow and possible changes in brain metabolism (including cerebral tissue oxygenation and glucose hypometabolism). Altogether, these changes in MRI-based measurements invite further investigation of the mechanisms that may underlie delirium, as a potential avenue to improve clinical management of people suffering with this condition.

References

Current Sentence C (Delirium#Pathophysiology#Neuroimaging): “Although neuroimaging offers a non-invasive way to understand delirium, it has been challenge to establish correlates with delirium.”

Proposed Updated Sentence C: Edits (mainly structural + update of reference): Neuroimaging provides an important avenue to explore the mechanisms that are responsible for delirium. Despite progress in the development of magnetic resonance imaging (MRI), the large variety in imaging-based findings has limited our understanding of the changes in the brain that may be linked to delirium.

References

Current Sentence D (Delirium#Pathophysiology#Neuroimaging): “Many attempts to image people with concurrent delirium are unsuccessful. In addition, there is a more general bias selecting younger and fitter participants amenable to scanning, especially if using intensive techniques such as MRI.”

Updated Sentence D: Edits (structural + clarification + source): Some challenges associated with imaging people diagnosed with delirium include participant recruitment and inadequate consideration of important confounding factors such as history of dementia and/or depression, which are known to be associated with overlapping changes in the brain also observed on MRI.

References

Current Sentence E (Delirium#Prevention): "Delirium may be prevented by systematically addressing the common contributing factors, such as constipation, dehydration, low oxygen levels, immobility, and the simultaneous use of multiple or problematic medications."

Updated Sentence E: Delirium may be prevented and treated by using non-pharmacologic approaches focused on risk factors, such as constipation, dehydration, low oxygen levels, immobility, visual or hearing impairment, sleep deprivation, functional decline and removing problematic medications.

References

Current Sentence F (Delirium#Treatment#Non-Pharmacologic Interventions): "Such interventions are the first measures in managing active delirium and has many overlaps with delirium preventative strategies, including optimizing the hospital environment by reducing ambient noise, providing proper lighting for the time of day, minimizing room changes and restraint use."

Proposed Updated Sentence F: These interventions are the first steps in managing acute delirium and there are many overlaps with delirium preventative strategies. In addition to treating immediate life-threatening causes of delirium (e.g. low O2, low blood pressure, low glucose, dehydration), interventions include optimizing the hospital environment by reducing ambient noise, providing proper lighting, offering pain relief, promoting healthy sleep-wake cycles, and minimizing room changes. Although multicomponent care and comprehensive geriatric care are more specialized for a person experiencing delirium, several studies have been unable to find evidence showing they reduce the duration of delirium.

References

Current Sentence G (Delirium#Treatment#Medications): "The treatment for delirium with medications depends on its cause. Low-dose haloperidol when used short term (one week or less) is the most studied and standard drug for delirium. Evidence for efficacy of atypical antipsychotics (i.e. risperidone, olanzapine, ziprasidone, and quetiapine) is emerging, with the benefit for fewer side effects. Antipsychotics however are not supported for the treatment or prevention of delirium among those who are in hospital. Benzodiazepines themselves can trigger or worsen delirium, and there is no reliable evidence for use in non-alcohol-related delirium. If the delirium involves alcohol withdrawal, benzodiazepine withdrawal, or contraindications to antipsychotics (e.g. in Parkinson's disease or neuroleptic malignant syndrome), then benzodiazepines are recommended. Similarly, people with dementia with Lewy bodies may have significant side effects to antipsychotics, and should either be treated with a none or small doses of benzodiazepines. The antidepressant trazodone is occasionally used in the treatment of delirium, but it carries a risk of over-sedation, and its use has not been well studied."

Proposed Updated Sentence G: Evidence for the effectiveness of medications (including antipsychotics and benzodiazepines) in treating delirium is inconclusive.Low-dose haloperidol when used short term (one week or less) is the most studied and standard drug for delirium. Evidence for efficacy of atypical antipsychotics (i.e. risperidone, olanzapine, ziprasidone, and quetiapine) is emerging, with the benefit for fewer side effects. Use antipsychotic drugs with caution or not at all for people with conditions such as Parkinson's disease or dementia with Lewy bodies. Benzodiazepines themselves can trigger or worsen delirium, and there is no reliable evidence for use in non-alcohol-related delirium. If the delirium involves alcohol withdrawal, benzodiazepine withdrawal, or contraindications to antipsychotics (e.g. in Parkinson's disease or neuroleptic malignant syndrome), then benzodiazepines are recommended. The antidepressant trazodone is occasionally used in the treatment of delirium, but it carries a risk of over-sedation, and its use has not been well studied.

References

Current Sentence H (#Delirium#Diagnosis#Differential Diagnosis): "Other processes and syndromes that cause cognitive dysfunction resembling delirium include the following:"

Proposed Updated Sentence H: There are conditions that might have similar clinical presentations to those seen in delirium. These include dementia, depression, psychosis, and other conditions that affect cognitive function. + Remove “Long term learning disorders” from the list of differential diagnoses

References

Proposed Change I (#Delirium#Diagnosis#Differential Diagnosis): Change the order of differential diagnoses from "Psychosis…,Dementia…, Depression…, Long term learning disorders…, Other mental illnesses…" to Dementia…, Depression…, Other mental illnesses…, Psychosis…

We look forward to your input.

14kl3 (talk) 19:58, 18 November 2019 (UTC)

Thank you for sharing your proposed article improvements. Do you mind including the page #s that you found the info for your text book reference? When editing the actual Wikipedia article you can re-use the same reference in the same Wikipedia article. When adding the reference using the visual editor while editing a wikipedia article, you can see the option to "reuse". Great work so far! JenOttawa (talk) 23:10, 18 November 2019 (UTC)

Consciousness

Hi everyone. I noticed the sentence "disturbances in consciousness" or something similar was removed and no longer written on the main page of Delirium. I have a feeling this is wrong, as Delirium does actually have some effect on consciousness. Would you say its okay to add that back, or, atleast explain, why was it removed? Since Delirium has many effects and symptoms, this is a prominent one, and I have personal experience with Deliriants I have used in my life with some medications, which cause Delirium. Noam111g (talk) 09:30, 3 November 2023 (UTC)

Okay. I have edited it to add the consciousness part. If anyone has a problem with that please let me know. Good Night. Noam111g (talk) 23:49, 3 November 2023 (UTC)

Wiki Education assignment: Global Poverty and Practice

This article was the subject of a Wiki Education Foundation-supported course assignment, between 23 August 2023 and 20 December 2023. Further details are available on the course page. Student editor(s): Ariellarose19 (article contribs). Peer reviewers: Csteel3777, Aksgpp3131.

— Assignment last updated by Aksgpp3131 (talk) 07:16, 19 December 2023 (UTC)