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^Delirium is a common clinical syndrome seen by the pediatric psychosomatic medicine consultant in general hospital settings. It is often unrecognized, overlooked, or misdiagnosed by physicians caring for the patient, and psychiatric consultations are usually requested for depression or agitation rather than delirium. The fluctuating nature of delirium often confounds the diagnosis (Inouye 1994). Psychiatrists consulting to pediatricians must be familiar with the clinical symptoms and approach to the treatment of delirium and recognize the risk delirium represents.

Delirium has been recognized since antiquity as a potentially lethal disorder. Hippocrates described mental abnormalities caused by fever, poisoning, or head trauma in 500 B.C. The term delirium was first used in medical writing by Celsus in the first century A.D. (Adamis et al. 2007). Over time, delirium has been called acute confusional state, acute brain syndrome, metabolic encephalopathy, toxic psychosis, intensive care unit (ICU) psychosis, global encephalopathy, and acute brain failure (Samuels and Neugroschl 2005).

Most studies of delirium, whether focusing on symptoms, etiology, risk factors, or prognosis, describe findings in elderly patients. These studies are difficult to apply to pediatric patients, whose brains have not undergone the changes in cytoarchitecture and neurochemistry that occur with advancing age. However, the delirium risk factors present in elderly patients, such as pathophysiological vulnerability, multiple medical problems, and the need for multiple medications (Rummans et al. 1995), may also be present in seriously ill children or adolescents. The etiology of delirium is complex and multifactorial, and although an attempt to identify the underlying condition that precipitated the delirium is usually considered essential, doing so is often impossible. Treatment begins with accurate diagnosis of delirium, followed by attempts to identify and address the presumed cause, and finally by efforts to ameliorate its effects on mood, behavior, and cognition.

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