By Thomas N. Wise, M.D., Editor-in-Chief of Psychosomatics, The Journal of Consultation-Liaison Psychiatry, and Department of Psychiatry, The Georgetown University School of Medicine, The Inova Fairfax Hospital, Falls Church, VA22042, USA
Delirium is often underdiagnosed and undertreated in medical settings. Consultation-liaison psychiatrists are well aware of organic brain syndromes that are often misdiagnosed as anxiety or depression. This book should be read by all physicians who may see individuals with delirium. The book discusses two separate subjects. First reviewed are the acute confusional states, seen in a variety of medical settings, such as those associated with metabolic impairment, the elderly, and individuals with neoplastic disease. The latter part of the book reviews psychological issues in the management of terminal patients and their families. Because of this, the volume is uniquely helpful to any physician who works with the seriously ill.
The book begins with a brief overview of the history of delirium, which was originally described by Hippocrates and in contemporary medicine most elegantly conceptualized by Bonhoeffer as acute exogenous psychosis. Engel and Romano then followed with their classic 1959 paper (J Chronic Dis 1959; 9:260-277) in which they linked the global slowing of the electroencephalogram to the clinical signs of encephalopathy. The various classification systems are discussed, with attention to concepts such as acute versus chronic, consciousness and confusion, and exogenous versus endogenous etiologic factors. The chapter on pathophysiology of delirium is important, since this is an area that is commonly neglected in our consultation-liaison literature. The work by van der Mast and colleagues, as well as Trzepacz et al., emphasizes important data in the pathophysiology of delirium. Very detailed chapters on the clinical phenomenology of delirium make this section mandatory for psychiatric trainees. The chapter on differential diagnosis is also essential for all physicians. The volume then goes on to discuss "frequent aetiologies" that include disease states but also a wide variety of medications. A table on drugs that combine to foster serotonin syndrome is particularly helpful in this age of polypharmacy. The book is remarkably current in its references. A chapter devoted to delirium in palliative and terminal care is also particularly helpful for individuals who work with cancer patients. The chapter on management and the discussion of anticipatory and complicated grief complete this book. It is beautifully produced, with judicious use of tables.
The appendices of the book have a wide variety of screening instruments, including the Mini-Mental State Examination, the revised Delirium Rating Scale, and the Memorial Delirium Assessment Scale.
The book is a pleasure to read in its clarity and clinical wisdom. Physicians in all specialties should read this book, since delirium is seen by all of us who treat very sick patients. It is an excellent addition to the libraries of consultation-liaison fellows and faculty. Drs. Caraceni and Grassi are well known, both in Europe and North America, for their wisdom in consultation-liaison psychiatry. This volume only underscores their abilities.