Diagnosis and Management of Acute Mental Status Changes: Delirium

Colleen M. Crumlish, MD, Elizabeth A. Cerceo, MD, FACP, FHM

SUMMARY

Delirium, a type of or acute confusional state, is a syndrome characterized by an acute change in cognition with altered consciousness and impaired attention that fluctuates over time. It is a common diagnosis in the hospitalized patient, especially in the elderly, and can be associated with serious complications. Delirium often goes unrecognized and untreated. Symptoms are wide ranging, thus a clinical diagnosis can be missed without a formal assessment. The following module provides hospitalists with methods for diagnosing and managing delirium. A management strategy for the prevention and treatment of alcohol withdrawal delirium is also discussed.

GOAL

Provide hospitalists with current diagnosis and management strategies for patients with delirium.

TARGET AUDIENCE

This activity is designed for hospitalists. 

LEARNING OBJECTIVES

After completing the module, the participant should be able to:

  1. Diagnose delirium and characterize the sub-types.
  2. Describe the morbidity and mortality associated with delirium, identify the incidence and prevalence of delirium in the inpatient setting, and explain the reasons for the high non-detection rates.
  3. List the predisposing and precipitating risk factors for developing delirium and discuss prevention strategies in the high-risk patient.
  4. Appreciate delirium as a medical urgency and describe an approach to the evaluation of delirium.
  5. Discuss nonpharmacologic and pharmacologic treatment strategies for delirium.
  6. Describe a management strategy for the prevention and treatment of alcohol withdrawal delirium.
ACCREDITATION STATEMENT

The Society of Hospital Medicine is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

CREDIT DESIGNATION STATEMENT

The Society of Hospital Medicine designates this activity for a maximum of 2 AMA PRA Category 1 CreditsTM. Physicians should only claim credit commensurate with the extent of their participation in the activity.

Release date: Novembe 3, 2017                  

Expiration date: Novembe 3, 2020

Estimated time to complete activity: 2 hours

CONFLICT OF INTEREST DISCLOSURE POLICY

In accordance with the ACCME Standards for Commercial Support, SHM requires that individuals in a position to control the content of an educational activity disclose all relevant financial relationships with any commercial interest. SHM resolves all conflicts of interest to ensure independence, objectivity, balance, and scientific rigor in all its educational programs. All relevant financial relationships shall be disclosed to participants prior to the start of the activity.

Furthermore, SHM seeks to verify that all scientific research referred to, reported, or used in a continuing medical education (CME) activity conforms to the generally accepted standards of experimental design, data collection, and analysis. SHM is committed to providing its learners with high-quality CME activities that promote improvements in healthcare and not those of a commercial interest.

INSTRUCTIONS

The following is an interactive educational module designed to help you gauge your basic knowledge of the topic and then direct you to areas you may need to focus on. It consists of several sections: a pre-test, a study program, a post-test, & CME evaluation. All sections must be completed to receive CME credit.

Course summary
Available credit: 
  • 2.00 AMA PRA Category 1 Credit™
  • 2.00 ABIM MOC Self Evaluation Points
    Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to 2.00 MOC points [and patient safety MOC credit] in the American Board of Internal Medicine's (ABIM) Maintenance of Certification (MOC) program. Participants will earn MOC points equivalent to the amount of CME credits claimed for the activity. It is the CME activity provider's responsibility to submit participant completion information to ACCME for the purpose of granting ABIM MOC credit
  • 2.00 Equivalent Credit
Course opens: 
11/03/2017
Course expires: 
11/03/2020
Cost:
$0.00
Parent activity set: 
Rating: 
0
FACULTY & FACULTY DISCLOSURES
Leonard Feldman, MD
Associate Professor of Medicine
Johns Hopkins University School of Medicine
Urban Health Residency and Track Director
Associate Program Director, Osler Medical Residency
Director, Comprehensive General Medicine Consult Service
Founding Editor-in-Chief, Consultative & Perioperative Medicine Essentials for Hospitalists
Baltimore, Maryland
Dr. Feldman reports having no relevant financial or advisory relationships with corporate organizations related to this activity.
 

Kurt Pfeifer, MD, FACP, SFHM
Professor of Medicine
General Internal Medicine
Medical Director, Froedtert and Medical College of Wisconsin Eye Institute Perioperative Services
Medical College of Wisconsin
Associate Editor-in-Chief, Consultative & Perioperative Medicine Essentials for Hospitalists
Milwaukee, Wisconsin
Dr. Pfeifer reports having no relevant financial or advisory relationships with corporate organizations related to this activity.

Colleen M. Crumlish, MD
Hospitalist and Assistant Professor of Clinical Medicine,
Department of Medicine
Hospital of the University of Pennsylvania
University of Pennsylvania School of Medicine
Philadelphia, Pennsylvania.
Dr. Crumlish reports having no relevant financial or advisory relationships with corporate organizations related to this activity.

Elizabeth A. Cerceo, MD, FACP, FHM (Reviewer for 2016)
Hospitalist and Assistant Professor of Medicine
Associate Program Director, Internal Medical Residency
Cooper University Hospital
Cooper Medical School of Rowan University
Camden, New Jersey
Dr. Cerceo reports having no relevant financial or advisory relationships with corporate organizations related to this activity.
 
Click here to download the references for this educational activity.
Accreditation Statement

The Society of Hospital Medicine is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to 2.0 MOC points [and patient safety MOC credit] in the American Board of Internal Medicine's (ABIM) Maintenance of Certification (MOC) program. Participants will earn MOC points equivalent to the amount of CME credits claimed for the activity. It is the CME activity provider's responsibility to submit participant completion information to ACCME for the purpose of granting ABIM MOC credit.

Available Credit

  • 2.00 AMA PRA Category 1 Credit™
  • 2.00 ABIM MOC Self Evaluation Points
    Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to 2.00 MOC points [and patient safety MOC credit] in the American Board of Internal Medicine's (ABIM) Maintenance of Certification (MOC) program. Participants will earn MOC points equivalent to the amount of CME credits claimed for the activity. It is the CME activity provider's responsibility to submit participant completion information to ACCME for the purpose of granting ABIM MOC credit
  • 2.00 Equivalent Credit

Accreditation Period

Course opens: 
11/03/2017
Course expires: 
11/03/2020

Price

Cost:
$0.00
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The following is an interactive educational module designed to help you gauge your basic knowledge of the topic and then direct you to areas you may need to focus on. It consists of several sections: a pre-test, a study program, a post-test, & CME evaluation. All sections must be completed to receive CME credit.

Click START to begin.