Which type of delirium is characterized by restlessness, agitation, and possible hallucinations?

• A. Hypoactive
• B. Hyperactive
• C. Mixed
• D. Delusional

Answer: (B)

Restlessness, agitation, and possible hallucinations are classic features of the hyperactive form of delirium. In this subtype, the brain’s acute dysfunction drives heightened arousal and disorganized thinking, leading to increased psychomotor activity. Patients may pace, shout, be easily distracted, and experience perceptual disturbances such as visual or other sensory misperceptions. This contrasts with hypoactive delirium, where the person becomes quiet, withdrawn, and less responsive, and with the mixed type, which alternates between hyperactive and hypoactive states. Delusional thoughts can occur in delirium, but labeling a subtype as “delusional” isn’t standard; the defining feature here is the marked motor agitation and potential hallucinations. In practice, recognizing hyperactive delirium is crucial for safety and timely management, which focuses on identifying and treating the underlying cause (infection, medication effects, dehydration, metabolic disturbances), ensuring a safe environment, reorientation, and using nonpharmacologic strategies first; medications like antipsychotics are considered only if agitation endangers the patient or others.