Understanding Delirium: Diagnosis-Prevention- and Evolving Best Practices
In Episode 2.4 of Psychiatry Boot Camp, we explore one of the most underrecognized, misunderstood, and dangerous neuropsychiatric conditions: delirium.
Our expert guest is 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. With years of clinical, research, and educational experience, Dr. Oldham leads a comprehensive, nuanced conversation about delirium’s complexity, risk, and relevance.
🧠 In This Episode, You’ll Learn:
✔️ The clinical definition and evolving understanding of delirium
✔️ How to distinguish delirium vs. encephalopathy in practice
✔️ The dangerous outcomes associated with untreated delirium
✔️ Validated assessment tools (like CAM-ICU, 4AT, and DDT-Pro)
✔️ Evidence-based prevention and management strategies
✔️ Neurobiological mechanisms and proposed pathophysiology
✔️ Pharmacologic vs. non-pharmacologic approaches
✔️ Delirium’s surprising evolutionary function in human survival
✔️ Key areas of ongoing and future research in consultation-liaison psychiatry
📌 Why Delirium Deserves More Attention:
Delirium is associated with:
Higher morbidity and mortality
Longer hospital stays and increased costs
Long-term cognitive decline
Greater burden on caregivers and health systems
And yet, it’s often missed, misdiagnosed, or mismanaged.
Dr. Oldham urges clinicians to reframe their understanding of delirium as a dynamic, systemic brain response, not just a side effect or confusion state. He provides frameworks to help clinicians spot subtle signs, respond early, and mitigate risks with better documentation, monitoring, and team communication.
🧠 Delirium vs. Encephalopathy:
One highlight of this episode is the clear explanation of how delirium differs from encephalopathy—not just linguistically but clinically and functionally. Understanding this difference can improve diagnostic clarity, especially in consult-liaison and critical care settings.
📚 Further Reading & References:
📎 Episode References: Visit Episode Page
• CAM-ICU, 4AT, and other assessment tools
• Neuroinflammatory hypotheses and evolving treatment models
• Delirium as an adaptive brain state: emerging theories
👨⚕️ About Dr. Mark Oldham:
• Associate Professor of Psychiatry, University of Rochester
• President-Elect, American Delirium Society
• Deputy Editor, Journal of the Academy of Consultation-Liaison Psychiatry
• Clinician and researcher advancing our understanding of acute cognitive syndromes
Dr. Oldham’s blend of academic rigor and frontline clinical insight makes this a must-listen for any clinician encountering acute cognitive change in medically ill patients.
🎯 Who Should Watch This Episode:
• Psychiatry and internal medicine residents
• Consultation-liaison psychiatrists and hospitalists
• ICU staff, palliative care providers, and geriatricians
• Neurologists, NP/PAs, and emergency clinicians
• Any healthcare professional working with older adults or acutely ill patients
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💬 Discussion Prompt:
How do you assess for delirium in your clinical setting? What challenges have you faced in managing or communicating about it? Share below!
📌 Timestamps (Suggested Layout):
00:00 – Intro to Dr. Mark Oldham and the Scope of Delirium
04:00 – Delirium vs. Encephalopathy
07:45 – Tools for Assessment: CAM, 4AT, and More
12:30 – Prevention Strategies and Risk Reduction
15:50 – Neurobiology of Delirium
19:10 – Pharmacologic & Non-Pharmacologic Management
22:40 – Evolutionary Role of Delirium
26:00 – Future Research Directions
29:00 – Final Reflections
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