What Is Delirium?

Delirium is a major mental condition that causes muddled thinking and decreased awareness of one’s environment. Delirium usually develops quickly, in a few hours or days. A severe or persistent disease, changes in metabolic balance (such as low sodium), medication, infection, surgery, alcohol, drug intoxication, or withdrawal are all common causes of delirium. Due to the fact that the symptoms of delirium and dementia are so similar, a doctor may need help from a family member or caregiver to establish an accurate diagnosis.

Delirium Vs Dementia

It can be difficult to tell the difference between dementia and delirium, and a person can have both. In reality, delirium is common in dementia patients, however, having delirium episodes does not automatically imply that a person has dementia. As a result, a dementia evaluation should not be performed during a delirium episode, as the results may be misleading. Here are some distinctions between delirium and dementia symptoms:

Onset

Delirium usually starts with small symptoms that progressively increase over time, whereas dementia usually starts with minor symptoms that gradually worsen over time.

Fluctuation

During the day, the appearance of delirium symptoms might change significantly and frequently. While persons with dementia have better and worse days, their memory and thinking abilities remain pretty consistent throughout the day.

Attention

With delirium, the capacity to stay focused or keep attention is severely hampered. A person with dementia in its early stages is often alert.

Types of Delirium

Hyperactive Delirium

This is possibly the most easily recognized type. Restlessness, agitation, fast mood changes, hallucinations, and refusal to comply with treatment or care are some of the symptoms of this type.

Hypoactive Delirium

Inactivity or decreased motor activity, sluggishness, abnormal sleepiness, or the appearance of being dazed are all examples of this.

Mixed Delirium

This covers symptoms of both hyperactive and hypoactive. An individual can go from being hyperactive to being hypoactive in a matter of seconds.

Symptoms of Delirium

Delirium usually manifests itself over a period of hours or days. It can change during the day, and there may be times when you don’t feel anything at all. Symptoms are more severe at night when it’s dark and things appear strange. These are some of the main symptoms of delirium:

Cognitive Impairment with Symptoms such as:

• Poor recall of recent events, in particular.
• Speech or memory problems
• Disorientation; for instance, not knowing where you are or who you are might cause disorientation
• Nonsensical or rambled speech
• Difficulty understanding speech
• Reading or writing difficulties
• Reduced environmental awareness

This results in:

• Being easily distracted by little matters
• Inability to stay focused on a specific issue or to switch between them
• Instead of responding to queries or discussion, you get hooked on an idea
• Being withdrawn, with little or no activity or reaction to the surroundings

Emotion Disturbance with Symptoms such as:

• Anxiety, fear, or paranoia are all symptoms of anxiety
• Anger or irritability
• Depression
• Apathy
• A feeling of being elated (euphoria)
• Mood swings that are sudden and unpredictable
• Personality morphs

Behavioral Changes with Symptoms such as:

• Hallucinations
• Restlessness, agitation, or aggressive behavior
• Yelling, muttering, or making other noises
• Quietness and withdrawal, especially in older people
• Lethargy or slowed mobility
• Disturbed sleep patterns
• Reversal of the sleep-wake cycle from night to day

Causes of Delirium

Delirium occurs when the brain’s normal sending and receiving of impulses is disrupted. This impairment is most likely caused by a combination of variables that render the brain vulnerable and cause brain activity to malfunction.
Delirium can be caused by a single factor or a combination of factors, such as a medical condition and drug toxicity. There are times when no cause can be found. Some possible causes of delirium are as follows:

• Medications that cause toxicity or drug toxicity
• A medical problem, such as a stroke, heart attack, or worsening lung or liver illness, or a fall injury
• Intoxication or withdrawal from alcohol or drugs
• Illness that is severe, chronic, or terminal
• Fever and a serious infection, especially in children
• Infections of the urinary tract, pneumonia, or the flu, especially in older individuals
• Toxic exposure to carbon monoxide, cyanide, or other toxins
• Dehydration or malnutrition
• Sleep deprivation or significant emotional discomfort
• Pain
• Anesthesia is used in surgery and other medical treatments.
• Low sodium or calcium levels, for example, can cause metabolic abnormalities.

Medications and Drug Combinations Can Cause Delirium:

• Anti-inflammatories
• Medications for sleep
• Mood-altering medications, such as those for anxiety and sadness
• Medications for allergies (antihistamines)
• Asthma treatments
• Steroid medications such as corticosteroids
• Drugs for Parkinson’s disease
• Drugs used to treat spasms and convulsions

Risk Factors of Derilium

Any disease that requires a hospital stay, especially in critical care or after surgery, raises the risk of delirium. Delirium is more common in people over 70 years.

Other factors that can increase the risk of delirium:

• undergoing surgery
• suffering from excruciating pain
• being disabled in some way
• having eyesight and hearing problems
• having a mild cognitive disability
• consuming too much alcohol
• consuming psychoactive medicines, such as painkillers, antidepressants, or hypnotic
• sleep aids, whether legal or illegal
• having a history of brain-injury disorders such as stroke and dementia
• anemia
• being a man

How to Diagnose Delirium

Delirium diagnosis is based on a patient’s medical history, mental state tests, and the presence of suspected contributory factors. An examination involves the following:

Physical and Neurological Examination

The doctor does a physical examination to look for indicators of illness or any other underlying disease. A neurological exam, which includes assessing vision, balance, coordination, and reflexes, can help to establish if the delirium is caused by a stroke or another neurological condition.

Mental Health Assessment

A doctor begins by evaluating the patient’s awareness, attention, and mental abilities. This can be done informally through discussion, or it can be done professionally with tests or screenings that examine mental state, confusion, perception, and memory.

How to Treat Delirium

Treatment for delirium may include taking or quitting particular drugs, depending on the cause. Because the symptoms of delirium are similar to those of dementia, a precise diagnosis is critical for therapy in older persons.

Medications for Delirium

Minute dosages of one of the following drugs can be given if the patient is agitated or depressed:

Antidepressants are used to treat depression
Sedatives help with alcohol withdrawal
Dopamine blockers are good for drug toxicity
Use thiamine to prevent confusion

Counseling

Counseling helps patients who have become disoriented as a result of drug or alcohol abuse. In certain circumstances, the treatment may be able to assist in abstaining from the substances that caused the delirium. Counseling brings ease and provides a safe environment for the expression of thoughts and feelings.

Supportive Care

Supportive care prevents complications in various ways, some of which are:

• Keeping the airway open
• Providing nutrients and fluids
• Providing assistance with moving
• Pain management
• Taking care of incontinence
• Using physical constraints and bladder tubes as little as possible
• When feasible, avoiding changes in surroundings and caregivers
• Encouraging family members or familiar members to assist

Now that you Know…

Targeting risk factors that might provoke an episode is the most effective way to prevent delirium. Frequent room changes, intrusive procedures, loud noises, bad lighting, and a lack of natural light and sleep make hospital surroundings particularly challenging. Certain techniques, such as maintaining healthy sleep habits, assisting the person in being calm and well-oriented, and preventing medical difficulties or other complications help avoid or minimize the severity of delirium.