Delirium - Causes, Symptoms and Treatment

Delirium is a transient global disorder of cognition . The clinical hallmarks are decreased attention span and a waxing and waning type of confusion.. Delirium is a condition of severe confusion and rapid changes in brain function. It is usually caused by a treatable physical or mental illness. Delirium requires medical attention as soon as possible. The outlook for recovery is good if the underlying condition can be reserved, as it often can be. While waiting for medical help, approach the patient in a calm, reassuring manner. If possible, keep him in a quiet, nonstimulating environment.

Other possible causes include physical and mental shock, exhaustion, head injury, liver or kidney failure, very low thyroid function, insufficient or excess blood sugar. Delirium also may occur in association with excessive intake of alcohol or sedatives, anesthesia, and following drug withdrawal (especially of alcohol and barbiturates). Delirium often is unrecognized or misdiagnosed and commonly is mistaken for dementia, depression, mania, an acute schizophrenic reaction, or part of old age. Delirium is a Disordered mental state with excitement and illusions, delirium can be brought on by almost any acute illness accompanied by very high fever.

Delirium itself is not a disease, but rather a clinical syndrome , which result from an underlying disease or new problem with mentation . delirium is simply the common symptomatic manifestation of early brain or mental dysfunction.delirium as a transient, usually reversible, cause of cerebral dysfunction and manifests clinically with a wide range of neuropsychiatric abnormalities. Most cases of delirium begin fairly suddenly. There is clouding of consciousness along with confusion, disorded speech,difficulty in comprehension, sometimes lack of appreciation of time, place, and (in severe cases) person. There may be overwhelming fear; less commonly, elation or depression; occasionally,excitabjIity,irritabjIity, and violent behavior. Delirium can be relatively brief (a matter of hours) or may last for weeks, often with fluctuations in which the patient appears better at times, wor'se at others. Commonly, the patient is worse during eveningsand at night.

Patients with delirium can present with agitation, somnolence, withdrawal, and psychosis.. Primary care physicians must be able to recognize delirium so that the underlying etiology can be ascertained and addressed.Delirium is a acute change in cognition and a disturbance of consciousness, usually resulting from an underlying medical condition or from medication or drug withdrawal.. The management of delirium involves identifying and correcting the underlying problem, and symptomatically managing any behavioral or psychiatric symptoms. This variation in presentation can lead to diagnostic confusion and, in some cases, incorrect attribution of symptoms to a primary psychiatric disorder. Keep the light dim but do not make the room totally dark. Watch closely to protect him from any self-injury. If necessary, restrain him by encircling his chest with a folded sheet; tie it under the bed. Should he endanger himself by flailing his arms, it may be necessary to tie each wrist, at his side, to the bed. Use sheets, not string or rope. which can cut off circulation or cut into the skin. Restraints should not be too tight; they should allow some movement. Be certain restraints are actually necessary; sometimes they can serve as an added exciting factor.

Causes of the Delirium

Common Causes of Delirium are

• Medications are the most common reversible cause of delirium.
• Substance intoxication delirium
• Substance withdrawal delirium
• Delirium due to multiple etiologies
• Miscellaneous causes, such as sensory deprivation, sleep deprivation, fecal impaction, urinary retention, and change of environment
• Unfamiliar environment

Symptoms of the delirium

Symptoms of the delirium are as follows:

• Difficulty maintaining or shifting attention
• Disorientation
• Illusions
• Changes in motor activities,and movement
• Emotional or personality changes

Neurological symptoms as following

• Tremor
• Asterixis in hepatic encephalopathy and uremia
• Motor abnormalities
• In patients who are elderly, delirium often is the presenting symptom of an underlying illness.
• Testing vital signs such as temperature, pulse, blood pressure, and respiration is mandatory.

Treatment of the Delirium

Medical care and treated methods are as follows:

• Components of delirium management include supportive therapy and pharmacological management.
• Fluid and nutrition
• For the patient suspected of having alcohol toxicity or alcohol withdrawal, therapy should include multivitamins, especially thiamine.
• Environmental modifications
• Sensory deficits should be corrected, if necessary, with eyeglasses and hearing
• confusion should be treated those include heart failure , decreased oxygen ( hypoxia ), excessive carbon dioxide levels ( hypercpnia ), thyroid disorders , anemia , nutritional disorders, infections, kidney failure
• Medications may be required to control aggressive or agitated behaviors or behaviors that are dangerous to the person
• In most adult patients with delirium of moderate severity, haloperidol therapy can be initiated at 1 to 2 mg twice daily, repeated every four hours as needed, and can be administered
• Physicians should not automatically discontinue antipsychotics on the first day the patient's mental status shows improvement, because the improvement may just be a normal fluctuation in the delirium