Delirium

Delirium is a condition that is characterized by severe confusion developing suddenly and spontaneously accompanied by rapid alterations of the functions of the brain resulting from mental or physical illness. Delirium is most commonly temporary and reversible. Some of the classical signs of delirium are severe confusion, cloudy thoughts, unclear and obstructed thinking, and disorientation.

It is also defined as the inability of a person to think or interpret with normal clarity or speed. It is associated with the feeling of disorientation, lack of concentration, difficulty in retrieving memories, inability to make decisions and difficult in paying attention. The DSM-IV recognizes Delirium as a mental disorder.

Considerations

Delirium or confusion may occur spontaneously or over a gradual course of time. This depends upon the cause and extent of delirium. In many cases, confusion is seen as a temporary condition which is reversible, but in many cases it cannot be cured and remains permanent. Confusion is mostly related to dementia or delirium and is commonly seen in elderly patients who show signs of degenerating brain function. Elderly patients showing signs of confusion often manifest them during hospital stays. Due to the nature of confusion, patients may feel disoriented and show unusual changes in the behavior or personality, they are also likely to act in an aggressive manner.

Causes

Delirium is most commonly caused as a result of a mental or physical ailment or illness. It is usually temporary and can be cured with the help of therapy and medication.

There are various conditions that can lead to the development of delirium which include oxygen deprivation of the brain cells due to inadequate blood flow. Some of the causes have been enlisted as follows:

  • Excessive alcohol intake
  • Drug withdrawal syndrome
  • Chemical disturbances occurring in the body such as electrolyte imbalance
  • Bacterial or viral infections such as urinary tract infections and pneumonia
  • Poisoning
  • Post surgical infections and disorders

Symptoms

Delirium is characterized by rapid changes in mental states and moods of a patient. This includes the rapid transition from agitation or lethargy, and then back to agitation or vice versa. Some of the symptoms associated with delirium include the following:

Delirium

Short term memory loss is a sign of delirium.

  • Altered alertness, which may be more pronounced in the morning in contrast to night
  • Alteration in feelings, including perceptions and sensations
  • Disturbances in the level of awareness and consciousness
  • Alternations and disturbances in sleeping routines and patterns
  • Feeling of disorientation and confusion which may occur at any given time and place
  • Difficulty in retrieving memories or recalling events. The patient does not seem to remember when a certain period or episode of delirium began, or what the events that occurred prior to the episode were.
  • Short term memory loss
  • Wandering attention, or the inability to maintain the normal level of concentration
  • Disorganized and disoriented thoughts, which may be described as ‘cloudy or vague’ by the patients
  • Emotional changes which may include irritability, anger, euphoria, agitation, nervousness, anxiety, depression and apathy.
  • Involuntary movements resulting from the abnormal functioning of the nervous system.
  • Incontinence

Home Care

One of the simplest methods of finding out whether a person is suffering from delirium is by asking their name, the current date and their age. In case they are slow in answering, unsure or unable to answer, it can be concluded that they are confused. Delirium can also occur as a result of low blood glucose in which case the person should be given a sweet snack or drink. In case the confusion persists for longer than ten minutes, medical attention should be sought. A person suffering from delirium must never be left alone and should be given, if required, physical restraints for safety purposes.

What Should I Do If My Loved One Suffers from Delirium?

If a family member or friend is suffering from delirium or confusion the following tips should be followed:

  • Introduce yourself, despite knowing the person very well
  • Remind the patient where he or she is
  • Place a clock and a calendar near the patient
  • Talk about plans for the day and current events
  • Try to maintain peaceful surroundings for the patient

People can also suffer from delirium due to low blood sugar. The person should be given a sweet drink to consume or eat a sugary snack. If the delirious state lasts longer than ten minutes, a doctor should be called.

https://www.disorders.org/hallucinogen-use-disorder/psychological-effects-of-hallucinogens/

Treatments

The main goal of treating the condition is to either reverse or control the main cause. The treatment wholly depends upon what is causing the delirium. The diagnosis and the care of the patient should take place in a place that is comfortable, pleasant and has a non-threatening environment and the patient should be kept safe from harm[4]. The location should also be physically safe. Some patients also require hospitalization for a certain period of time.

Some medicines can also worsen the confused state if suddenly stopped, these are:

  • Analgesics, such as, hydrocodone, oxycodone or morphine
  • Alcohol
  • Anticholinergics
  • Cimetidine
  • Central nervous system depressants
  • Lidocaine
  • Illicit drugs

Treating mental and medical disorders usually greatly improves the mental functioning of the patient.

Medications

Medications might be needed in order to control violent or aggressive behavior or states of extreme agitation. These medications include:

  • Dopamine blockers (risperidone, haloperidol or quetiapine)
  • Antidepresssants (if the person also suffers from depression)
  • Sedatives such as clonazepam and diazepam (usually given for alcohol or sedative withdrawal)
  • Thiamine

Other Treatments

  • Modification of behavior to control dangerous or unacceptable behavior
  • In order to reduce disorientation, reality orientation should be done.

Prognosis

Delirium due to acute conditions can be because of dementia causing disorders. Acute brain syndrome can be reversible if the cause is treated.

References:

http://www.nlm.nih.gov/medlineplus/ency/article/000740.htm

DSM-IV The Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition

http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001749/

Blueprints Psychiatry Michael J Murphy, Ronald L. Cowan, Lloyd I Sederer

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