Pathophysiology [ACK is the primary nearotransmitr believed t be involved in lium, abd the primary neuroanatomical sit valved isthe ‘steula formation Thus, one ofthe frequet causes of dali is the use of drugs with igh entiolageriepoteaual. As the inca ste of regulation of arousal and atenton, the reticular Formation and its neuroantomiesl connections ply 2 major role {nthe syaploms of doliiom, The majo pally involved in de rium isthe dorsal tegmental pathway projecting from the mes cncephali ticular formation othe tectum and the thal Clinical Features According to DSMCIVCTR, the primary fate of delim isa Aliminihed clarity of awareness ofthe eavionment (American Pyychiarie Asociton, 1994) Spmptems of dlilam ae char sterically global, of seus onset, uctusting and of elatively trie duration. Inmot cases of delirium, an ofien overlooked po- rome of aed slep patterns, unexplained fig, Hstating ‘ond, sleep phobia, relesnesannety and nighimares occ ‘Aroviw of masing nts for tho Jays before te recognize onset ‘of delirium oftenilustats erly warning sigs ofthe condition, Sever mvetigatore hive vee he clinical etoree cf delinum ito abeormaltes of 1) arousal, 2) language and ngnton 3) pecepon, 4)oretton,S} md, 6) eepand wake fulnes tel 1) netoogical netioning (Replat 1994) about them. Paranoia and sleep phobia may result. Typi “The seo arousal in delirious pts yb in or ecrned Some pints exit marke restless, Rg rod st hyperilanc and nese alrnee This perm $Fonen seen nae of witeval hom depremie wrens (Gs akeel or inoxieton by alae (phencyain Dhstomine, hscrpe aed sethyamids. Patent wth need Srousl om ne sich concomitant aoc ses salle. ‘esting, tahycads, mydass, hyperterm, pseecton tnd gatottinal dices There pcs fen requ sod din wih neues or bouzdacpinesHiypenctne wus ‘ace ach es tae occsonaly soon megs excephalpay tnd hypercapnia rece initaly perceive as depressed rd. tented dae The cea corse of dlciom in my parton (pti nay inched ol need and ders rae en. Siang such nchuels pay yt edt wih octal ‘gation and beavorl poles Gundowning). Percept bao lism pci an inbty to actininnte sensory stil an to neg caret peep tine wih pet experienes Consul, pallens dv po tenis events, convraons unt fr that do 2 Getly pertain to the, bvame obsciaed wih svat simul abd ismerpet js fn thr environment. The miner tone gene Take efor of ary and isl ons Patents wah sad iba, kr example, might hea Be Sunt ofver tig and pre an oneine whispering visual illusions are that intravenous tubing is a snake or worm crawling into the skin, or that a respirator is a truck or farm vehicle about to collide with the patient, The former auditory illusion may lead to tactile hallucinations, but the most common hallucinations in delirium are visual and auditory. Orientation is often abnormal in delirium. Di: rientation in particular seems to follow a fluctuating course, with patients unable to answer questions about orientation in the morning, yet fully oriented by the afternoon. Orientation to time, place, person and situation should be evaluated in the delirious patient. Gener- ally, orientation to time is the sphere most likely impaired, with orientation to person usually preserved. Orientation to significant people (parents, children) should also be tested. Disorientation to self is rare and indicates significant impairment. The examiner should always reorient patients who do not perform well on any portion of the orientation testing of the mental status examination, and serial tes ing of orientation on subsequent days is important.