1st February 2024

Clinical presentation

In general, features include:

• Patients appearing distressed and distracted 
• Patients being disorientated with poor awareness of time, place and person
• Disorganised thinking
• Inattention
• Mood swings
• Visual and auditory hallucinations
• Paranoid and persecutory delusions- especially fear of others plotting against or trying to hurt or harm them.
• Poor speech and conversation
• Inability to do things that have been done in the past (simple day-to-day activities)
• Altered sleep-wake cycle
• Inappropriate or unsafe behaviours (challenging behaviours)
• Emotional lability
• Loss of appetite

In addition to the above symptoms, the following features may be specific in the different types of delirium:

Hypoactive delirium

• Excess sleep/somnolence
• Reduced arousal and inability to stay focused when being awake
• Lethargic and mute
• Withdrawn
• Mistaken as depression as many of the symptoms could be suggestive of depressive illness
• Risk of delayed diagnosis and delayed management
• Very quiet and silent
• Poor eating and less mobile

Hyperactive delirium

• Increased agitation and restlessness
• Hypervigilance and increased anxiety
• Aggression, physical and verbal aggression
• Increased sympathetic activity (Increased heart rate and temperature, blood pressure)
• Nausea, diarrhoea
• Psychotic symptoms
• Challenging behaviour
• Resisting personal care

Mixed presentation

They will switch between hyper and hypo symptoms.