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Delirium: Symptoms, Causes, Treatment, Prevention

Overview

In delirium the brain trips and fumbles. Delirium is a change in the functioning of the brain that results in confused thinking and reduced awareness of the environment. It is common and can be cured. Usually, the start of delirium is fast — within hours or some days.

What is Delirium?

A sudden change in a person’s mental faculties (how well the brain is functioning) causing confusion, disorientation and even impaired consciousness is described as delirium. It is a common disorder and may be seen in association with other psychiatric conditions.

Causes of Delirium

There are many causes of delirium:

  • Brain trauma, for example, a head injury
  • Brain infections like meningitis and encephalitis
  • Brain tumours
  • Epilepsy
  • Endocrine problems related to pancreas, thyroid, parathyroid and pituitary glands
  • Drugs like anticonvulsants, antihypertensive, insulin and steroids
  • Alcohol intoxication or withdrawal
  • Deficiency of B vitamins like thiamine, folate, nicotinic acid and B12
  • Liver or kidney disease affecting the brain (encephalopathy)
  • Electrolyte imbalance
  • Cardiac failure or irregular heartbeat
  • After a major surgery
  • Disorders related to blood vessels

Symptoms and Signs of Delirium

Psychiatric symptoms: Disturbances in sleep – wake cycle, mood swings, abnormal behaviour, hallucinations and delusions, agitation, irritability, anxiety, depression. The person may be drowsy in the day as their night sleep is for a short duration and fragmented.
Neurological symptoms: Tremors, incontinence (inability to control urine), lack of coordination while walking, impairment in consciousness.
Impairment of cognitive functions: Problem in understanding speech, loss of recent memory, difficulties in reading, writing, speaking and disorientation.
Inability to stay in the present: Wandering attention, inability to respond to questions, getting distracted frequently, lack of focus.

The symptoms of delirium occur suddenly and may last for hours or days. The symptoms keep changing so it is important for the relatives of the person to note them down, or they may be missed.

Delirium may be confused with dementia but there are some differences. For instance, dementia has a gradual onset while delirium is immediate. Also, in dementia, alertness is present in the early stages, while in delirium, alertness and memory loss is significant.

The symptoms may be fewer during the day, but at night they are severe. This is called ‘sun downing.’

Diagnosis of Delirium

While diagnosing delirium, it is important to know the history of the medication the person is on, if there is alcohol/drug abuse, if he is HIV positive and if he has any major medical conditions. Also, it is helpful to know if there are changes in his behaviour, mood and other mental functions. A complete neurological and psychiatric evaluation is of paramount importance.

Investigations for Delirium

  • Blood tests for electrolytes, liver and kidney function, complete blood count and levels of vitamin B may be necessary.
  • Urine routine test and culture if required.
  • ECG, chest X-ray, EEG, ELISA test for HIV.
  • CT or MRI of brain if tumours or epilepsy is suspected.

Treatment of Delirium

The treatment of the cause is of primary importance as symptoms rapidly improve once the cause is treated.
Any electrolyte or nutritional imbalances must be corrected.
Psychiatric treatment for accompanying psychiatric illnesses is recommended – for e.g. antipsychotics to control irritability and agitation.

Prevention of Delirium

It is important to identify what triggers delirium, especially if the patient is hospitalised. Correction of fluid and electrolyte imbalance, avoiding loud noises, getting adequate fresh air and good diet are all important.

It is also important to place a clock where the time can be easily seen, place a calendar in the room and have the person surrounded with people he is close to.

Support for those suffering from delirium

A person having episodes of delirium needs constant care and support of his near and dear ones, especially if he has a terminal illness such as AIDS or untreatable cancer. Some tips are as follows:

  • Set up a regular routine for the person and make sure he follows it.
  • Make sure he takes his medication regularly.
  • Good nutrition and regular exercise is a must.
  • Keep familiar objects in the room in the same place, but avoid cluttering.
  • Keep a clock and calendar where the person can easily see it.
  • See that he goes to sleep at the same time daily; avoid caffeine at night as it disturbs sleep patterns.
  • Avoid loud sounds or noisy areas. A peaceful and calm atmosphere is recommended.
  • Schedule regular visits to the physician.
  • Ensure good nursing care if needed.
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