75.2 NEUROBIOLOGY OF DELIRIUM

Abstract

The goal of this session is to describe the current understanding of the neurobiology of delirium with a specific focus on children. The presentation will include proposed mechanisms of delirium and discuss clinical evaluation and management in the pediatric population. A literature review will examine the neurobiology of pediatric delirium with a discussion of its clinical application. Adult literature will be included to incorporate our evolving understanding of the neuroscience of delirium. A vignette will be presented to guide the audience through clinical screening, assessment, and management, demonstrating the application of understanding of neurobiology in a critically ill child. The review will address the variability of clinical presentation and clinical management depending on the subtype of delirium and the underlying etiology of delirium, and it will highlight the importance of structured monitoring of symptoms and response to interventions. Pediatric delirium is a syndrome representing complications from multiple critical care etiologies. The child and adolescent psychiatrist must consider the various pathways to disruption of the brain’s ability to attend to and process the environment. Delirium is, by definition, a fluctuating level of consciousness, which makes careful assessment and ongoing tracking of symptoms critical in order to understand the clinical options to manage the syndrome. The fluctuations complicate the ability to distinguish delirium and catatonia; treatment varies depending on the syndrome, and the neurobiology of the 2 syndromes may lead to challenges in treatment when comorbid. The vignette will demonstrate the application of clinical understanding of delirium for effective management. Pediatric delirium is a syndrome resulting from critical illness in children. Studies have identified significant mortality as well as long-term morbidity when not adequately managed. Delirium and catatonia may co-occur, emphasizing the importance of understanding the neurobiology of delirium. Child and adolescent psychiatrists can benefit from understanding the acute assessment and management of delirium as well as the long-term outcomes potentially seen in outpatient practices.