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Delirium

By Smriti Sharma


Introduction


Delirium is an organic decline in the mental functioning of an individual that includes discrepancies in attention, cognition, and consciousness. The onset is rapid, within a few hours to days, and involves neurological deficits with emotional disturbances and mental confusion. Also known as the acute confusional state, this syndrome lies somewhere in the spectrum between normal awakeness and coma and includes symptoms of:

  • Delusions: A state of contradiction by reality or rationality.

  • Disorientation: State of mental confusion.

  • Hallucinations: State of illusion, delusion, a figment of the imagination.

  • Disturbances of sleep: Insomnia, sleep apnea, and so on.

  • Disorganized thoughts and language: Mood disorders, dementia, schizophrenia, or psychotic disorders.

Although a serious issue, it is a syndrome and not a disease. It occurs rapidly, within a few hours to days. With proper supervision and care, it can definitely be cured.


Classification of Delirium


Experts have classified three types of delirium:


1. Hyperactive delirium

  • This type of delirium is easy to recognize.

  • Characterized by agitation, rapid mood changes or hallucinations, and refusal to cooperate.


2. Hypoactive delirium

  • The most common type of delirium.

  • Characterized by reduced motor activity, drowsiness.

  • Patients tend to sleep more, be inattentive, and be disorganized.


3. Mixed delirium

  • Includes symptoms of hyperactive and hypoactive delirium.

  • The patient conveys symptoms of hyperactive and hypoactive delirium.


4. Delirium tremens

  • This is the most severe form of delirium.

  • This is experienced by people who are trying to stop drinking.

Causes of Delirium


A predisposing condition of a disease is a primary factor that leads to the occurrence of this mental condition. Some of them are:

  1. Patients with Parkinsonism, liver diseases, and stroke.

  2. Kidney failure and patients on dialysis.

  3. People with physical restraints, and lack of sleep.

  4. Patients taking high doses of medication.

  5. Alcohol withdrawals.

Epidemiology


It is common for elderly patients to have delirium. Studies have shown that 10 to 30 % of geriatric patients are affected by it.


The chart below shows the percentage of incidence of occurrence of delirium in hospitalized patients.


Dementia and Delirium


It is a common factor that people are confused between dementia and delirium. However, they are completely different and have no resemblance whatsoever. Dementia is a gradual loss of memory due to the gradual loss of functioning of brain cells. The main cause of it is Alzheimer's disease. It is common that people with dementia are likely to have delirium but it is not the same the other way around.


Diagnosis of Delirium


Confusion assessment method


Use of the confusion assessment method by practitioners to diagnose delirium include:

  • How well the patients cope with the activities they are surrounded by.

  • Speech

  • Thought processing.

Other diagnostic methods


The diagnostic methods to rule out whether the patient has delirium or not are:

  • Chest X-ray

  • Full blood picture

  • Scan of the head

  • Urine sampling

  • Liver tests

  • Drug and alcohol screening.

Treatment


Medicine


Proper diagnosis of the underlying disease is the primary factor while aiming to treat delirium. For example, patients with asthma may suffer severe attacks during delirium. Proper monitoring of medicine to retore the breath is necessary. Certain medicines are also prescribed to relieve depression, alcohol withdrawal as and when deemed necessary by the practitioner.


Counseling


Counseling is advised to patients with alcohol and drug withdrawal. The psychologist should maintain a safe space for his/ her clients to feel free to share their thoughts and feelings.


Recovery


Patients with delirium have a 100 % success rate when given the right medication and counseling. Considering the severity of the condition, the time of recovery may vary from a few weeks to months.



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