Delirium in the Elderly

Part 1 The concept of delirium: formal psychiatric diagnostic system - the ICD system - the DSM system - nosological problems; research assessments of delirium - the elderly - the importance of delirium in the elderly - the size of the problem; delirium and distress; the outcome of delirium. Part 2 Clinical assessment and diagnosis: assessment - history - examination of the mental state - clinical investigations; clinical features - cognitive function - perception - psychomotor behaviour - emotion - physical signs; screening for delirium; differential diagnosis - dementia - other organic mental disorders - depression - mania - anxiety states - paranoid states and schizophrenia - catatonia - other functional disorders. Part 3 The causes of delirium: physical factors - drug therapy - infection - metabolic, endocrine and nutritional causes - cardiovascular and respiratory disorders - intractarial lesions - intra-abdominal causes - alcohol and drug abuse - surgery and anaesthesia - rarer causes of delirium; psychiatric disorders - dementia - depression and anxiety - schizophrenia - factors associated with psychiatric disorder - the effects of psychiatric treatment; personality; sensory deprivation; adverse life events and difficulties - bereavement - relocation and institutionalization. Part 4 The neutral basis of delirium: introduction; delirium associated with metabolic disturbance - the cholinergic hypothesis - monoaminergic dysfunction and delirium - other central neurotransmitters and delirium - delirium associated with structural lesions; delirium associated with psychological trauma; conclusions. Part 5 The management of delirium - at home or in hospital - involuntary admission to hospital - physical aspects of management - what and when to investigate; treatment of specific causes - drug withdrawal - minimizing introgenic discomfort - psychological aspects of management - treatment - treating the effects of delirium - treating the cause of delirium - planning discharge and preventing recurrence. Part 6 The future - an agenda for research - definitions - assessment - epidemiological studies - pathogenesis - evaluation of interventions.