Mixed delirium refers to which situation?

• A. Symptoms of both hyperactive and hypoactive delirium
• B. Consistent hyperactivity without cognitive fluctuations
• C. Pure hypoactivity
• D. Seizure activity with delirium

Answer: (A)

Mixed delirium means the patient’s delirium symptoms swing between hyperactive and hypoactive states. At times the person is agitated, restless, and easily distractible; at other times they are quiet, lethargic, or less responsive, with attention and cognition fluctuating. This variability can occur over hours to days, so you don’t see a single, steady pattern. It’s not simply constant hyperactivity or pure hypoactivity, and it isn’t defined by seizures. In practice, recognize that delirium can present as a mix of behaviors, and management focuses on identifying and treating reversible causes, ensuring safety, and using nonpharmacologic strategies first, with medications only if agitation endangers the patient or staff and then with careful consideration of risks.