Of the 3 informative articles included in this special geriatric collection, 1 offers a perspective on the treatment of depression that does not focus on somatotherapy. The others remind us of 2 additional geriatric Ds of importance: drugs and driving.

I teach doctors and nurses how to assess, treat, and prevent delirium—an acute confusional disorder caused by multiple medical problems that mimics mental illness—but is actually a medical emergency.


Delirium has been recognized and described since antiquity. It is a brain disturbance manifested by a syndrome of diverse neuro­­psychiatric symptoms. Various terms have been used for delirium, such as acute brain disorder, metabolic enceph­alopathy, organic brain syndrome, and ICU psychosis.

Delirium is characterized by an altered level of consciousness, decreased attention span, acute onset, and fluctuating course. Approximately 15% of elderly patients admitted to the hospital have delirium as a presenting or associated symptom. Delirium will develop in another 15% of elderly patients during hospitalization.

In this issue, Drs Heinrich and Sponagle present a thorough overview of the challenges of detecting and treating delirium in the emergency care setting. They also address the high risks involved when the diagnosis is missed. The difficulties of identifying and appropriately managing delirium are not new. However, the importance of doing so is taking on a greater significance because of certain current and forecasted realities that will affect the nation's emergency departments (EDs).

The review article, case presentations, and commentary on delirium in this issue of Psychiatric Issues in Emergency Care Settings provide a comprehensive overview of a challenging medical disorder. This issue is particularly useful for physicians and mental health care providers who work in emergency departments (EDs), on psychosomatic services, and on inpatient units with a significant geriatric population.


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