Typhus is named after delirium: Greek typhos, the smoke or haze of the fevered, stuporous mind. Typhoid means "typhus-like".

Diseases were once named for the confusion they caused.

We kept the diseases and forgot the mind.

#delirium

Offer the patient the story afterwards.

When delirium clears, people are usually left with minimal or no understanding of what the heck happened to them.

Tell them, and provide information, e.g. with leaflets. www.deliriumsupport.com provides this.

#delirium

Post-operative delirium often begins in recovery, not on the ward.

The first frightened hours after anaesthesia pass unwitnessed if we only screen at the next routine ward checks.

It's good practice to screen in the recovery room (PACU).

#periop #delirium

“Months of the year backwards, starting with December?”

“December. November. October. September. No. Wait. I’ve lost it.”

Thirty seconds, no kit. Inattention is the core feature of delirium, and this is the 4AT's attention item. Her full score: 6 of 12; 4 or more is positive.

#delirium #4AT

"They told me I'd been 'a bit confused'. That is not what it was like."

For the patient, delirium can be terror and certainty of harm.

When we call it "a bit confused", we wave away the worst hours of their life.

Match your language to their reality.

#delirium

Delirium comes on in hours and can take weeks to clear. Onset: hours to days.

Clearing: days to weeks.

Full recovery: sometimes months, and not always complete. Tell families early.

Expectation is part of the care.

#delirium

Study spotlight: older adults given trazodone (a sedating antidepressant) for delirium symptoms after discharge had fewer readmissions and deaths than those given antipsychotics.

41,268 older adults (Yang et al., Lancet Healthy Longevity 2025). Observational (not a randomised trial).

#delirium

The 4AT (a delirium test) needs no family informant.

Mr Williams is markedly drowsy, yet last week he collected his prescription in person: evidence of acute change.

Alertness 4, questions 2, attention 2, acute change 4: 12/12, possible delirium.

Score item 4 from the evidence.

#Delirium #4AT

#ArtificialIntelligence in #Delirium Care: Predicting, Detecting, and Preventing Delirium in Older Hospitalized Adults | Cureus

www.cureus.com/articles/532...

#MedEd #AIinHealthcare #HealthAI #HealthTech

In older adults, serious illness often has none of the textbook signs. Sepsis without fever.

Heart attack without chest pain.

What shows instead is new confusion.

Delirium can be the only visible sign of an emergency. Work it up.

#delirium

Goya, "Self-Portrait with Dr Arrieta" (1820): the painter, half-collapsed after a fever that nearly took his reason, is held up by his doctor.

One of art's great images of dangerous illness, and the one steadying figure a frightened patient needs.

#delirium #art

"I should have realised sooner." Carers carry that for years.

Delirium is missed daily by trained professionals.

A relative who noticed something was wrong at all has often outperformed the system. Raising the alarm was the job.

#delirium

A representative case, details changed for anonymity:

"It wasn't until a geriatrician reviewed my mother's medications that we found the cause of her sudden confusion. A new sleeping pill...

Within two days of stopping it, she was back to her old self."

#delirium

Give the family a job.

Watching someone you love be confused, with nothing to do, is its own suffering.

Hand them a role: bring the glasses, a photo, sit, talk about ordinary things, tell us when he seems himself.

#delirium

Looking for experts in evidence mapping, guideline reviews, and evidence synthesis to support a WHO project on delirium in older adults.

Remote assignment (Oct-Dec 2026).

Interested? Contact me directly. Please share.

#Delirium #Geriatrics #EvidenceSynthesis #WHO

Missed #delirium = longer stays, more complications, higher mortality, massive costs.

But hey, at least we saved 2 minutes by not doing a 4AT (the delirium test) in the emergency department.

For delirium researchers:

Publishing delirium research should not require a four-figure fee.

Delirium is open access: €20 to submit and a €280 publishing charge (APC) on acceptance.

Peer review normally takes an estimated 4 to 6 weeks.

deliriumjournal.com/for-aut...

#Delirium

Waking from anaesthesia into blur and silence is disorientation by design.

Glasses and hearing aids should travel to theatre with the patient and go back on as they wake. Cheap, kind, protective.

#periop #delirium

The 4AT (a bedside delirium test scored 0 to 12) does not need a family informant.

Mr Williams is markedly drowsy. Evidence of recent independent activity supports an acute change: alertness 4, questions 2, attention 2, acute change 4: 12 out of 12.

Score item 4 from the evidence.

#Delirium #4AT

Robert-Fleury's painting of Pinel striking the chains from asylum patients (1876) commemorates a radical idea: the confused are ill, not dangerous, and care beats restraint.

Modern delirium practice is the same argument in modern dress.

#delirium #history