Up to 10% to 31% of patients may have delirium at admission, and it may develop in up to 56% of admitted patients [8], particularly following surgery or in the intensive care unit [8]. Delirium is commonly precipitated by 1 or more underlying cause, including another medical condition, intoxication, or withdrawal [9]. Management is based on treatment of the underlying cause, control of symptoms with nonpharmacological approaches, medication when deemed appropriate, and effective aftercare planning [3,6,10]. The economic impact of delirium in the United States is profound, with total costs estimated at $38 to $152 billion each year [11]. New onset psychosis is often listed as a separate subgroup under the AMS category. Delusions and hallucinations are 2 cardinal features of psychotic symptomatology. Additional symptoms may include disorganized speech or thought, disorganized or abnormal motor behavior including catatonia or agitation, and negative symptoms such as diminished expression of emotions [9]. In contrast with other presentations of AMS, awareness and level of consciousness in patients with psychosis are frequently intact [12]. If the psychotic symptoms are related to an underlying psychiatric disorder, such as schizophrenia, bipolar disorder, schizoaffective disorder, or depression with psychotic features, it is termed primary psychosis. Secondary causes of psychosis are thought to be directly related to drug/alcohol use, withdrawal, or an underlying medical cause [1,2] and are not better explained by delirium [9]. Medical conditions that may present with psychotic symptoms include endocrine disorders, autoimmune diseases, neoplasms and paraneoplastic processes, neurologic disorders, infections, genetic or aStanford University School of Medicine, Stanford, California. bPanel Chair, Uniformed Services University, Bethesda, Maryland. cPanel Vice-Chair, Columbia University Medical Center, New York, New York.
Altered Mental Status Coma Delirium and Psychosis. Up to 10% to 31% of patients may have delirium at admission, and it may develop in up to 56% of admitted patients [8], particularly following surgery or in the intensive care unit [8]. Delirium is commonly precipitated by 1 or more underlying cause, including another medical condition, intoxication, or withdrawal [9]. Management is based on treatment of the underlying cause, control of symptoms with nonpharmacological approaches, medication when deemed appropriate, and effective aftercare planning [3,6,10]. The economic impact of delirium in the United States is profound, with total costs estimated at $38 to $152 billion each year [11]. New onset psychosis is often listed as a separate subgroup under the AMS category. Delusions and hallucinations are 2 cardinal features of psychotic symptomatology. Additional symptoms may include disorganized speech or thought, disorganized or abnormal motor behavior including catatonia or agitation, and negative symptoms such as diminished expression of emotions [9]. In contrast with other presentations of AMS, awareness and level of consciousness in patients with psychosis are frequently intact [12]. If the psychotic symptoms are related to an underlying psychiatric disorder, such as schizophrenia, bipolar disorder, schizoaffective disorder, or depression with psychotic features, it is termed primary psychosis. Secondary causes of psychosis are thought to be directly related to drug/alcohol use, withdrawal, or an underlying medical cause [1,2] and are not better explained by delirium [9]. Medical conditions that may present with psychotic symptoms include endocrine disorders, autoimmune diseases, neoplasms and paraneoplastic processes, neurologic disorders, infections, genetic or aStanford University School of Medicine, Stanford, California. bPanel Chair, Uniformed Services University, Bethesda, Maryland. cPanel Vice-Chair, Columbia University Medical Center, New York, New York.