Pathophysiology

The functions of intellect as well as arousal are disordered in the central nervous system in delirium. Pathologic mechanisms are complex and are thought to involve widespread neuronal or neurotransmitter dysfunction. Four groups encompass most patients: primary intracranial disease; systemic diseases that secondarily affected the CNS; exogenous toxins; and drug withdrawal.1 Delirium implies the presence of an acute reversible organic cause, unlike dementia, which is usually stable or slowly progressive and only sometimes amenable to treatment. Differentiation from acute psychosis on a pathophysiologic basis may be more problematic in that the psychosis may occur related to medical conditions in addition to psychiatric or functional conditions. Clinically, psychosis is less likely to have a waxing and waning pattern, and while reality perception is impaired, consciousness is not clouded ( T.a.ble 221il).

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