deliriogenic

Deliriogenic is an adjective used in medicine to describe factors, substances, or conditions capable of precipitating delirium. Delirium is an acute, fluctuating disturbance of attention, awareness, and cognition, often with perceptual disturbances and reduced ability to focus. Deliriogenic factors can be pharmacologic or nonpharmacologic and are especially relevant for older adults and patients with preexisting cognitive impairment or critical illness.

Pharmacologic agents known to be deliriogenic include anticholinergics (for example, oxybutynin, diphenhydramine), benzodiazepines and other sedative-hypnotics, opioids at certain doses, corticosteroids, antihistamines, and situations involving polypharmacy that increase anticholinergic burden. Alcohol and benzodiazepine withdrawal are also highly deliriogenic. In hospitals, intensive care, and palliative care, environmental factors, sensory overload or deprivation, sleep disruption, metabolic disturbances (electrolyte abnormalities, dehydration, hypoxia), infection, organ dysfunction, and uncontrolled pain can contribute to delirium.

Mechanistically, deliriogenic effects are thought to involve disruption of neurotransmitter systems (notably reduced cholinergic activity with secondary imbalances in dopamine, glutamate, and GABA signaling), neuroinflammation, and impaired regulation of attention and cortical networks. Age-related vulnerability and preexisting cognitive impairment amplify risk.

Prevention and management emphasize minimizing exposure to known deliriogenic agents, careful medication review and dose adjustment for age and organ function, prompt treatment of infections and metabolic derangements, maintaining hydration and nutrition, ensuring sleep and orientation, and involving caregivers and multidisciplinary teams in care planning. The term denotes risk factors and does not constitute a diagnosis.