PINCHME: The Common Causes of Delirium

Pain, Infection, Nutrition, Constipation, Hydration, Medication and Environment.

What is Delirium? According to the Royal College of Psychiatrists, delirium is a state of mental confusion that can happen if you become medically unwell.  It is also known as an 'acute confusional state'.

 Medical problems, surgery and medications can all cause delirium. It often starts suddenly and usually lifts when the condition causing it gets better. It can be frightening – not only for the person who is unwell but also for those around him or her.


PINCHME is a commonly used mnemonic that can be used to assist in identifying the common causes of delirium to ensure rapid and successful treatment.

The Infographic

The infographic below has been designed for use within nursing or residential settings to educate both staff and patients on the common causes of delirium.

You can download a high-resolution version of this image to print or distribute hereWe only ask that it is not modified without contacting and an appropriate citation is used.


  • Pain - Does your patient have uncontrolled pain?
  • Infection - Are they known to have a source of infection or could an infection be likely?
  • Nutrition - Does your patient have adequate nutrition? Could they be at risk of refeeding syndrome?
  • Constipation - When did your patient last have their bowels open? Could they be constipated?
  • Hydration - Are they drinking enough? Does that patient require supplementary fluids? Dehydration and over-hydration can cause changes to electrolytes.
  • Medication - Could any medication be causing the delirium? A full review of medication should be undertaken by a doctor.
  • Environment - Is it too loud? Is it too hot? Too bright? Ask your patient if anything around them is causing distress.

If someone becomes suddenly confused, they require an urgent medical review and to treat delirium effectively you need to identify and treat the cause.