Episode 3.4 – Delirium Explained: Causes-Brain Changes & How to Manage It
with Dr. Mark Oldham, Associate Professor of Psychiatry at the University of Rochester Medical Center, President-Elect of the American Delirium Society, and Deputy Editor of the Journal of the Academy of Consultation-Liaison Psychiatry.
In this essential follow-up to Episode 3.3, Dr. Mark Oldham returns to guide us through the underlying pathophysiology and clinical management of delirium. While delirium is often encountered at the bedside, understanding why it happens—and how to intervene thoughtfully—is crucial for improving patient outcomes.
Whether you're a psychiatry resident, internist, hospitalist, or C-L psychiatrist, this episode will deepen your understanding of both the science and art of managing delirium across medical settings.
🔍 What You’ll Learn:
🔹 Pathophysiology of Delirium
Explore the neurobiology of delirium, including how predisposing vulnerabilities (like dementia or sensory impairment) interact with precipitating factors (like infection, medications, or metabolic issues) to trigger acute cognitive decline.
🔹 Neurocircuitry & Neurotransmitters
Understand the brain circuits and neurotransmitter imbalances implicated in delirium—especially dopaminergic excess and cholinergic deficiency—and how these insights can guide treatment.
🔹 Conceptual Frameworks for Management
Learn how to organize your clinical thinking around identifying underlying causes, symptom-based intervention, and the non-pharmacologic strategies that form the foundation of care.
🔹 Management of Specific Symptoms
We walk through practical strategies for managing agitation, hallucinations, sleep disturbances, and hypoactive states in delirium—balancing the need for safety with the risks of pharmacologic sedation.
🔹 Role of the Psychiatric Consultant
Dr. Oldham shares clinical pearls on how consultation-liaison psychiatrists can support primary teams in managing delirium effectively—especially through education and structured assessments.
🧠 Key Takeaways:
✅ Delirium results from complex systems failure in the brain—not simply a psychiatric issue
✅ Targeting the root cause is always more effective than treating surface symptoms
✅ Antipsychotics should be used judiciously and only when absolutely necessary
✅ Multi-disciplinary teams play a critical role in delirium prevention and recovery
⏱️ Episode Timestamps:
00:00 – Introduction to Dr. Oldham & overview
02:50 – Predisposing vs. precipitating factors
07:10 – Neurotransmitters and circuitry in delirium
13:40 – Conceptual models of delirium pathogenesis
18:25 – Pharmacologic vs. non-pharmacologic management
25:00 – Managing specific neuropsychiatric symptoms
32:15 – Communication and collaboration with primary teams
38:00 – Summary and clinical application
🔗 References & Additional Resources:
📄 Episode Website & Citations
📘 American Delirium Society: https://americandeliriumsociety.org
🧠 CAM (Confusion Assessment Method): Link
👨⚕️ Who Is This For?
Psychiatry residents & C-L fellows
Internal medicine & emergency physicians
Hospitalists & geriatricians
ICU & palliative care teams
Nurse practitioners & physician assistants
Medical students seeking clarity on delirium care
💬 Why This Episode Matters:
Delirium is common, serious, and preventable. Yet without a clear understanding of its biological basis and clinical trajectory, many patients suffer unnecessarily. This episode offers both the scientific grounding and practical framework needed to improve detection and management of delirium in real-world settings.
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