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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
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)
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)
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.
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
Clinical importance by setting and predictors of outcomes
Signs and symptoms (Rewritten with contribution from David Meagher, 10.12.12)
Pathophysiology
Causes (added 8.2.13)
Prognosis (added 20.11.12)
Diagnosis in different care settings
Prevention (covering the major RCTs)
Treatment (covering the major RCTs)
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)
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)
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.
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)
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)
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)
Delirium in the Emergency Department - doi:10.1136/emermed-2011-200586 JFW | T@lk 20:48, 21 March 2013 (UTC)
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)
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.
Received request to merge the Mental confusion ( | talk | history | protect | delete | links | watch | logs | views) article into the Delirium ( | 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)
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)
( ←) 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)
doi:10.1186/s13054-014-0674-y - EEG may help prognosticate. JFW | T@lk 20:37, 13 December 2014 (UTC)
doi:10.1186/s13054-015-0886-9 JFW | T@lk 12:12, 23 April 2015 (UTC)
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)
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)
Review doi:10.1001/jama.2017.12067 JFW | T@lk 18:48, 26 September 2017 (UTC)
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)
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!
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)
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)
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)
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. [1]
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. [1]
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. [1]
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. [1]
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. [1]
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. [1]
References
{{
cite web}}
: CS1 maint: unflagged free DOI (
link)
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. [1] [2]
References
{{
cite web}}
: CS1 maint: unflagged free DOI (
link)
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. [1] [2] + 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)
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)
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)
This article is rated B-class on Wikipedia's
content assessment scale. It is of interest to the following WikiProjects: | ||||||||||||||||||||||||
|
Ideal sources for Wikipedia's health content are defined in the guideline
Wikipedia:Identifying reliable sources (medicine) and are typically
review articles. Here are links to possibly useful sources of information about Delirium.
|
Archives: 1 |
|
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
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)
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)
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.
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
Clinical importance by setting and predictors of outcomes
Signs and symptoms (Rewritten with contribution from David Meagher, 10.12.12)
Pathophysiology
Causes (added 8.2.13)
Prognosis (added 20.11.12)
Diagnosis in different care settings
Prevention (covering the major RCTs)
Treatment (covering the major RCTs)
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)
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)
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.
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)
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)
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)
Delirium in the Emergency Department - doi:10.1136/emermed-2011-200586 JFW | T@lk 20:48, 21 March 2013 (UTC)
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)
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.
Received request to merge the Mental confusion ( | talk | history | protect | delete | links | watch | logs | views) article into the Delirium ( | 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)
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)
( ←) 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)
doi:10.1186/s13054-014-0674-y - EEG may help prognosticate. JFW | T@lk 20:37, 13 December 2014 (UTC)
doi:10.1186/s13054-015-0886-9 JFW | T@lk 12:12, 23 April 2015 (UTC)
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)
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)
Review doi:10.1001/jama.2017.12067 JFW | T@lk 18:48, 26 September 2017 (UTC)
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)
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!
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)
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)
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)
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. [1]
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. [1]
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. [1]
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. [1]
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. [1]
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. [1]
References
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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. [1] [2]
References
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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. [1] [2] + 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)
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)
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)