As the name suggests, the mixed type of delirium combines features of the hyperactive and hypoactive types. It tends to have one of the following appearances: talking calmly to the person in short clear sentences, reassuring them as to where they are and who you are

Delirium is often preventable, but most preventive measures are things only clinical personnel should do. However, family, friends and loved ones can play a very important role in reducing the risk of delirium. When you're dying and no longer moving around, the mucus can build up and cause a rattling sound when you breathe. Confusion and hallucinations Medication (or Pharmacological intervention) should only be used when the individual is acutely agitated or aggressive and they have become a risk to themselves or others. Some medications such as sedatives can sometimes make the delirium worse. In some cases ‘antipsychotic’ medication will be given to: Burry L, Hutton B, Williamson DR, et al. Pharmacological interventions for the treatment of delirium in critically ill adults. Cochrane Database Syst Rev. 2019 Sep 3;9:CD011749. The term sub-syndromal delirium has also been used to define partially resolved or incomplete forms of delirium. Epidemiology

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A disturbance in attention (i.e., reduced clarity of awareness of the environment) is evident, with reduced ability to focus, sustain, or shift attention. This disturbance in consciousness might be subtle, initially presenting solely as lethargy or distractibility, and might be frequently dismissed by clinicians and/or family members as being related to the primary illness. Your breathing may become less regular. You may develop Cheyne-Stokes breathing, when periods of shallow breathing alternate with periods of deeper, rapid breathing. The recommendations in this guideline represent the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, professionals and practitioners are expected to take this guideline fully into account, alongside the individual needs, preferences and values of their patients or the people using their service. It is not mandatory to apply the recommendations, and the guideline does not override the responsibility to make decisions appropriate to the circumstances of the individual, in consultation with them and their families and carers or guardian. Nonmedical drug or medication use. Nonmedical use of drugs, including using prescription medications in a way other than prescribed, can cause drug-induced delirium.

Your healthcare professionals can discuss alternative ways of taking medicine with you and your carers, if necessary. Patients may not remember why they are in hospital, and they may be hyper-alert and very observant of what is happening around them (so they will become ‘over-stimulated’). Martin JC, Liley DT, Harvey AS, Kuhlmann L, Sleigh JW, Davidson AJ. Alterations in the functional connectivity of frontal lobe networks preceding emergence delirium in children. Anesthesiology. 2014;121:740–52.You'll start to feel more tired and drowsy, and have less energy. You'll probably spend more time sleeping, and as time goes on you'll slip in and out of consciousness. Not wanting to eat or drink There aren’t any medications that treat delirium directly. Instead, medications treat underlying causes or specific delirium symptoms. That means the treatments can vary widely depending on the contributing factors and your symptoms. Healthcare providers may consider antipsychotic medications for treating hyperactive delirium because they reduce agitation and combativeness. John, a retired teacher, was admitted to hospital after he broke his leg. A few days after his surgery his physiotherapist noticed that he seemed reluctant to work with her. The nurses on the ward noticed that his appetite was poor and that he wasn’t drinking enough – they wondered if he had become depressed. A blood test showed that his kidneys weren’t working as well as they should. A specialist nurse noticed that he did not know where he was or why he was there, and that he could not pay attention to their conversation. Finucane AM, Jones L, Leurent B, et al. Drug therapy for delirium in terminally ill adults. Cochrane Database Syst Rev. 2020 Jan 21;1(1):CD004770.

Some people may be restless or seem to be in distress. For example, they may want to move about, even though they are not able to get out of bed, or they may shout or lash out. Persistent delirium has been found to be frequent in older hospitalised patients, and associated with adverse outcomes. [14] Cole MG, Ciampi A, Belzile E, et al. Persistent delirium in older hospital patients: a systematic review of frequency and prognosis. Age Ageing. 2009 Jan;38(1):19-26.The medical team can rule out or treat any underlying causes, such as pain, breathing problems or infection, or calm the person who is dying. Prevalence of delirium ranges from 10% to 40% in older hospitalised patients. [5] Brown TM, Boyle MF. Delirium. BMJ. 2002 Sep 21;325(7365):644-7. It could be a side effect of taking certain drugs, or immobility, constipation, dehydration, or sleep deprivation – or simply the experience of being in hospital. Usually, patients have multiple drivers for their delirium rather than just one thing.

If you have delirium, the disruption in your brain function means you won’t be truly aware of or able to understand what’s happening to you. It also affects your memory, judgment and control over what you say and do. It can be a consequence of low oxygen level, infections, kidney or liver disease, or even a sign of withdrawing from substances – for example if someone is used to smoking but has been in hospital for a long time.It can be easy not to notice that someone has hypoactive delirium, because they may be very quiet. The person may stop eating as much or become less mobile than usual. They may spend more time in bed. Mixed delirium Zayed Y, Barbarawi M, Kheiri B, et al. Haloperidol for the management of delirium in adult intensive care unit patients: a systematic review and meta-analysis of randomized controlled trials. J Crit Care. 2019 Apr;50:280-6. making sure that any hearing aids and glasses are clean and working and that the person is wearing them Patients are brought to the operating room either walking, in a toy car and occasionally with child life accompanying. At our institution, parental presence is rarely performed and only on insistence from the family. Anesthetic conduct Delirium can have different causes. We may need to do medical tests to help decide what treatment is needed.