Delirium

Delirium is also known as an acute confusional state. It represents a severe disturbance in mental abilities. Therefore, the patient will become confused and will have a reduced awareness of the surrounding environment. Delirium starts very quickly, usually within hours or a few days. There are many causes that lead to delirium. For example, chronic medical illness, changes in the metabolic balance, medication, infection, surgery or alcohol withdrawal can lead to delirium.

What Are The Symptoms?

Delirium’s symptoms start over a few hours or days. Usually, the fluctuate during the day. However, there can be moments of the day when the symptoms are not visible. It may be possible that the symptoms to get worse during the night. The explanation lies in the fact that it is dark and everything looks less familiar.

Reduced awareness of the environment may result in:

  • The patient is not able to stay focused on a topic or to switch topics
  • The affected person gets stuck on an idea rather than responding to questions or conversation
  • The person gets easily distracted by unimportant things
  • He or she offers little response to the environment

Poor thinking skills (cognitive impairment) may appear as:

  • Poor memory, particularly of recent events
  • Disorientation. There are cases when the patient does not know where he or she is
  • Difficulty speaking or recalling words
  • Rambling or nonsense speech
  • Trouble understanding speech
  • Difficulty reading or writing

Behavior changes may include:

  • Seeing things that don’t exist. These are known as hallucinations
  • Restlessness, agitation or combative behavior
  • Calling out, moaning or making other sounds
  • Being quiet and withdrawn — especially in older adults
  • Slowed movement or lethargy
  • Disturbed sleep habits
  • Reversal of night-day sleep-wake cycle

Emotional disturbances may appear as:

  • Anxiety, fear or paranoia
  • Depression
  • Irritability or anger
  • A sense of feeling elated (euphoria)
  • Apathy
  • Rapid and unpredictable mood shifts
  • Personality changes

Types of delirium

There are three types of delirium:

  • Hyperactive delirium is the easiest to recognize. It includes restlessness (for example, pacing), agitation, rapid mood changes or hallucinations.
  • Hypoactive delirium includes inactivity or reduced motor activity, sluggishness, abnormal drowsiness or seeming to be in a daze.
  • Mixed delirium includes both of the above-mentioned types. The person may quickly switch back and forth from hyperactive to hypoactive states.

Delirium and dementia

Sometimes it is difficult to distinguish dementia from delirium. What is more, a person may have both. However, delirium appears most of the time in people with dementia. Therefore, these 2 conditions are connected.

There are several differences between the symptoms of delirium and dementia. They include:

  • Onset. The onset of delirium occurs within a short time. On the other hand, dementia usually begins with relatively minor symptoms that gradually worsen over time.
  • Attention. The ability to stay focused or maintain attention is significantly impaired with delirium. A person in the early stages of dementia remains generally alert.
  • Fluctuation. The appearance of delirium symptoms can fluctuate significantly and frequently throughout the day. While people with dementia have better and worse times of day, their memory and thinking skills stay at a fairly constant level during the course of a day.

How Is Delirium Diagnosed?

Confusion Assessment Method

One of the first methods that a doctor will try is to observe the existent symptoms and check whether you can think, speak and move normally. This is a good method to diagnose delirium or not. Therefore, the doctor checks whether or not:

  • your behavior changes throughout the day, especially if you’re hospitalized
  • you have a hard time paying attention or following others as they speak
  • you’re rambling

Tests and Exams

The brain chemistry can be affected by many factors. The doctor will run several tests in order to check the relevant symptoms and medical history. One or more of the following tests may be needed to check for imbalances:

  • blood chemistry test
  • head scans
  • drug and alcohol tests
  • thyroid tests
  • liver tests
  • chest X-ray
  • urine tests

How Is Delirium Treated?

Medications

Your doctor will prescribe medications to treat the underlying cause of delirium. For example, if your delirium is caused by a severe asthma attack, the doctor will recommend an inhaler or breathing machine to restore your breathing. If a bacterial infection is causing the delirium symptoms, antibiotics may be prescribed.

There are also cases when the doctor will recommend to stop taking certain medications or drink alcohol. Moreover, in case you feel agitated or depressed, the doctor may give you the following:

  • antidepressants to relieve the depression
  • sedatives to ease alcohol withdrawal
  • dopamine blockers to help with drug poisoning
  • thiamine to help prevent confusion

Counseling

This method is very efficient especially when you need help to anchor your thoughts. It can also be used as a treatment for people whose condition makes them engage in dangerous behaviors. However, counseling is very good especially when you need to feel safe in one place and discuss your thoughts and feelings.

 

Important points to remember in delirium

  • Patients suffering from this condition are vulnerable.
  • If not diagnosed and treated in time, delirium can become a serious condition for anyone.
  • Do not assume confusion is due to long-term dementia or mental handicap even in the elderly and those with learning difficulties:
    • It is important to check the previous level of function from relative/carer/home circumstances.
    • If this is not possible, treat as acute confusion until proven otherwise.
  • The doctor should always perform a full physical examination. This includes airway/breathing/circulation and vital signs; however, it is important to keep in mind that not all patients with delirium are very cooperative.
  • Blood glucose and pulse oximetry are also very important to be checked.

References:

https://medlineplus.gov/ency/article/000740.htm

http://www.mayoclinic.org/diseases-conditions/delirium/basics/symptoms/con-20033982

http://www.healthline.com/symptom/delirium

https://en.wikipedia.org/wiki/Delirium

 

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