C-L Case Conference: A 73-Year-Old Man with “Altered Mental Status” and Agitation.

Delirium is one of the most common reasons for psychiatric consultation in the general hospital. Delayed recognition can lead to increased morbidity and mortality among other complications. Learning to identify and address delirium is an essential part of consultation-liaison (C-L) psychiatry training.
In this case conference we present a common clinical scenario of a patient with hyperactive delirium attributed to urinary tract infection and discuss the case through review of the literature to teach general principles in evaluation and management of delirium.
A systematic approach to delirium includes screening, chart review, collateral interview, and the psychiatrist’s physical examination. The only definitive treatment of delirium is to diagnose and address underlying pathology. Thoughtful assessment includes standard tests paired with additional work-up tailored to the specifics of a given case. Nonpharmacological interventions can be helpful for delirium prevention, but antipsychotic medications are the mainstay for management of obstructive or dangerous psychomotor activity in hyperactive and mixed deliria.
The abilities to diagnose and manage delirium are core components of the C-L psychiatrist’s skill set. While the overall focus here is on practical guidance for trainees, C-L psychiatrists of all career stages would benefit from awareness of advancements in the field including the changing role of the electroencephalogram.