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Answer generated on June 4, 2024
The AI-generated responses are for illustration purposes only and should not be used for medical purposes.
The three subtypes of delirium are hyperactive, hypoactive, and mixed motor subtype.
Hyperactive delirium is characterized by increased motor activity, agitation, and sometimes hallucinations.[1-2]
Hypoactive delirium presents with decreased motor activity and arousal, leading to increased lethargy and a higher risk of morbidity and mortality.[1-2]
Mixed motor subtype of delirium features fluctuations between hyperactive and hypoactive symptoms, often within a 24-hour period.[1-3]
Delirium is a complex clinical syndrome that impacts attention and cognition, presenting acutely and with fluctuating severity. The categorization into hyperactive, hypoactive, and mixed subtypes helps in tailoring clinical approaches and interventions. For instance, hypoactive delirium, which is more common but less often recognized due to its less overt symptoms, is associated with worse outcomes compared to the more noticeable hyperactive subtype. Understanding these subtypes is crucial for effective management and may influence decisions regarding pharmacological interventions, as different subtypes might respond differently to treatments such as antipsychotics or sedatives.[1-3]
1.
Manak, Colleen K., Kim, Rosa K. (2025). In Nelson Textbook of Pediatrics (pp. 294). DOI: 10.1016/B978-0-323-88305-4.00048-1
Criteria for the diagnosis of delirium are included in the DSM-5 under Neurocognitive Disorders (Table 48.1). Delirium presents with anacute onset, developing quickly over the course of hours to days and symptoms tend towax and wane.This fluctuation of symptoms can be dramatic over the course of a day, with a patient appearingrelatively well from a cognitive perspective during one assessment, and then seeming acutely altered at the next. At the core of delirium is an alteration in attention and awareness, and a disturbance in cognition. Patients with delirium will struggle to focus and sustain attention. They are often disoriented, showing confusion about where they are, poor orientation to time, and sometimes disorientation to self. In addition to these core features, delirium often presents with symptoms that have the potential to be mistaken for psychosis or mania. People with delirium may hallucinate, engage in bizarre or purposeless movements, and show alterations in their sleep–wake cycles. Delirium can be further categorized into subtypes (Table 48.2). Thehyperactivesubtype is characterized by increased motor activity, loss of control of activity, restlessness, and wandering. Thehypoactivesubtype presents with reduction in activity, speed of actions, awareness of surroundings, quantity and speed of speech, and alertness. It is possible for patients to present with both hyperactive and hypoactive symptoms over the course of 24 hours, classified as having amixed motor subtype. There has been emerging evidence of a fourth group, identified as theno motor subtype, in which they do not show characteristics of either hyper- or hypoactive subtypes. Although these subtypes are often seen in both pediatric and adult delirium, diagnosing delirium in children can pose challenges not present in adult populations. Developmental differences, especially in young children, necessitate alternative approaches to assessing and diagnosing delirium. Bedside staff and caregivers can provide helpful insight into behaviors and cognitive changes, such as changes in attention, increased fussiness over baseline, and difficulty soothing, which might be missed by clinicians who are unable to evaluate symptoms of delirium using traditional methods (Fig. 48.1).
2.
Elsevier ClinicalKey Clinical Overview
Diagnosis AMS is often classified into the categories of delirium, dementia, and psychosis Delirium is an acute change in attention, cognition, or consciousness that develops over hours to days and is accompanied by hypoactive, hyperactive, and mixed behavioral changes. Hyperactive delirium often presents as agitation and combativeness with accompanying delusions and hallucinations Hypoactive delirium presents as decreased arousal and increased lethargy. This type of delirium is associated with higher rates of morbidity and mortality Mixed delirium is characterized by fluctuations between hyperactive and hypoactive delirium Dementia is a progressive change or decline in memory and cognitive function, typically seen in older patients Psychosis is characterized by delusions, hallucinations without insight into reality, or both
3.
la Cour KN, Andersen-Ranberg NC, Weihe S, et al. Critical Care (London, England). 2022;26(1):53. doi:10.1186/s13054-022-03931-3. Copyright License: CC BY
Publish date: March 4, 2022.
BACKGROUND: Delirium is the most common cerebral dysfunction in the intensive care unit (ICU) and can be subdivided into a hypoactive, hyperactive, or mixed motor subtype based on the clinical manifestation. The aim of this review was to describe the distribution, pharmacological interventions, and outcomes of delirium motor subtypes in ICU patients. METHODS: This systematic scoping review was performed according to the PRISMA-ScR and Cochrane guidelines. We performed a systematic search in six major databases to identify relevant studies. A meta-regression analysis was performed where pooled estimates with 95% confidence intervals were computed by a random effect model. RESULTS: We included 131 studies comprising 13,902 delirious patients. There was a large between-study heterogeneity among studies, including differences in study design,... (truncated preview)
