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Delirium in old age
  1. A Burns

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    Edited by J Lindesay, K Rockwood, A Macdonald (Pp 238, £55.00). Published by Oxford University Press, Oxford, 2002. ISBN 0-19-263275-2

    Delirium is an extremely important condition for a number of reasons. It is very distressing and frightening for those who experience the symptoms, and descriptions of the effects on the brain as a result of high fever have been well described. There is a high mortality associated with the development of delirium, and it is often associated with behavioural disturbances that can be troublesome for carers and attendants. Finally, it presents a unique opportunity to look at the interface between psychiatric symptoms caused by organic disease and functional disorders.

    Twelve years ago, the same publishers and two of the current editors produced the first edition on delirium. It was a relatively thin book but set the standards that the current edition continue. Delirium is certainly a niche market, and there appear to be no direct competitors, although textbooks on old age psychiatry usually contain chapters and notes on delirium. The new edition is greatly expanded and very much up to date.

    Every aspect of delirium is included, from the history and conceptual basis of the disorder through epidemiology, neurophysiology, clinical assessment, management, prevention, and, refreshingly, the the role of family caregivers and nurses in managing the disease. The core tenet of the book is that delirium is a disorder that is relatively poorly recognised (particularly the hypo-alert type) by the general clinical professions, it is relatively easy to identify people at risk of developing delirium, and that there is a real possibility of a reasonable preventive strategy for the disorder. Twelve authors have contributed and, as delirium is relatively under-researched, this probably represents a significant proportion of the leading researchers in the field internationally. There are particularly interesting sections on the conceptual basis of the disorder and how it, and its component symptoms, are defined, methods of assessment of delirium are covered comprehensively, a summary of how evidence based management plans can be developed, and the prospects of prevention of delirium are given an adequate airing.

    An interesting spin, which I discovered by accident, is that on the Oxford University Press website (, one can see online updates of each individual chapter. Those present when this author last visited the website (December 2002) consisted of work that had been done from when the manuscript had been submitted to publication. It may be that reviews of the book might also appear online—this one will.

    The book is a landmark in the literature on delirium, is a text of very high quality, and anyone seriously involved in the clinical management of patients with delirium or research on the subject would do very well to read this book.