Hypoactive delirium

New quiet withdrawal, drowsiness, slowed responses, poor intake after acute illness/surgery/medication change

EmergentReview due

Compare (8)

At a glance

High risk: Yes
Onset: Acute
Course: Fluctuating
Treatable: Often

Safety snapshot

Sepsis, hypoxia, retention, constipation, aspiration, medication toxicity.

Watch forSepsishypoxiaretentionconstipationmetabolic derangementdrug toxicity

Presentation hinge

Characteristic motor syndrome rather than simple low mood, psychosis, or "behavioural refusal". Mood disorders are a very common substrate.

Separates the Psychomotor Retardation / Mutism / Severe Withdrawal group. It is not specific to Hypoactive delirium.

Do now

1Test attention directly rather than accepting a quiet patient as settled
2Take a collateral history for the timeline, because withdrawn presentations are routinely missed on the ward
3Screen for infection, hypoxia, electrolyte disturbance, urinary retention, constipation and drug effect
4Review sedating and anticholinergic load, and escalate to the medical team if the conscious state is dropping

Locally authored, reviewed by PsychSift on 27 September 2026

Clinical review

Rows marked “Whole group”: Applies to the Psychomotor Retardation / Mutism / Severe Withdrawal group — not specific to Hypoactive delirium

Why it fits

New quiet withdrawal, drowsiness, slowed responses, poor intake after acute illness/surgery/medication change

Key features2 features

Motor syndrome with characteristic catatonic signs. Not simply very depressed or non-engaging.
Quiet, staring, slowed, withdrawn, inattentive

Must-not-miss

Sepsis, hypoxia, retention, constipation, aspiration, medication toxicity.

High-risk causes8 causes

Sepsis
hypoxia
retention
constipation
aspiration
medication toxicity
metabolic derangement
drug toxicity

Bedside question

Applies to the Psychomotor Retardation / Mutism / Severe Withdrawal group.

Characteristic motor syndrome rather than simple low mood, psychosis, or "behavioural refusal". Mood disorders are a very common substrate.

Helpful clues1 clue

Motor syndrome with characteristic catatonic signs. Not simply very depressed or non-engaging.

Immediate action

Applies to the Psychomotor Retardation / Mutism / Severe Withdrawal group.

Use structured screen (Bush-Francis), examine motor signs, check vitals/hydration/CK, think benzodiazepine challenge early Catatonia is more often mood-linked than many clinicians expect Treat the catatonia specifically Benzodiazepines and/or ECT are first-line Run a full delirium workup Hypoactive delirium is a major mimic

Priority steps8 steps

1The medication chart is often the shortest route to the diagnosis
2Quiet delirium is commonly missed and often medically dangerous
3Use structured screen (Bush-Francis), examine motor signs, check vitals/hydration/CK, think benzodiazepine challenge early
4Catatonia is more often mood-linked than many clinicians expect
5Treat the catatonia specifically
6Benzodiazepines and/or ECT are first-line
7Run a full delirium workup
8Hypoactive delirium is a major mimic

Investigations

Applies to the Psychomotor Retardation / Mutism / Severe Withdrawal group.

Vitals, oxygen saturation, Creatine kinase, Neuroimaging (CT/MRI), EEG, Lumbar puncture / CSF studies

Core tests5

Vitals, oxygen saturation
Creatine kinase
Neuroimaging (CT/MRI)
EEG
Lumbar puncture / CSF studies

Mimics / overlap

Applies to the Psychomotor Retardation / Mutism / Severe Withdrawal group.

None listed

Consider

Do now

1Test attention directly rather than accepting a quiet patient as settled
2Take a collateral history for the timeline, because withdrawn presentations are routinely missed on the ward
3Screen for infection, hypoxia, electrolyte disturbance, urinary retention, constipation and drug effect
4Review sedating and anticholinergic load, and escalate to the medical team if the conscious state is dropping

Locally authored, reviewed by PsychSift on 27 September 2026

First-line tests

Applies to the Psychomotor Retardation / Mutism / Severe Withdrawal group — not specific to Hypoactive delirium

Vitals, oxygen saturation
Creatine kinase
Neuroimaging (CT/MRI)
EEG
Lumbar puncture / CSF studies

Watch for

Sepsis
hypoxia
retention
constipation
metabolic derangement
drug toxicity

Also consider

Source and review

Review due· Unverified

v10 · exported 2026-07-11

Clinical reference — not validated decision support. Review before use.