What is Delirium?
There are three main types of delirium:
1 . Hyperactive delirium involves agitation, restlessness and sometimes hallucinations.
2 . Hypoactive delirium involves sleepiness, sluggishness and reduced responsiveness.
3 . Mixed delirium fluctuates between hyperactive and hypoactive states.
Cause
Delirium is caused by an underlying medical condition or from medication effects, substance intoxication or withdrawal. Some common causes include infections, electrolyte imbalances, organ failure, surgery and medications with anticholinergic properties. Delirium often results from multiple factors occurring together that disrupt normal brain functioning.
Symptoms
The core symptom is inattention – reduced ability to focus, sustain or shift attention. Other cognitive deficits include memory impairment, disorientation, language disturbance, and perceptual issues like hallucinations and delusions. There may also be mood changes, anxiety, agitation, activity changes and sleep-wake cycle disruption.
Diagnosis
Delirium needs prompt assessment and management to identify underlying causes and prevent complications. Screening tools like the Confusion Assessment Method allow clinicians to assess the severity and features. Lab tests, brain imaging and medication reviews help diagnose causes.
Treatments
The main treatment is addressing the underlying illness or toxicity triggering delirium through appropriate medical care. Providing a calm, well-lit environment, reorienting the person and having familiar faces around can help reduce agitation and disorientation. Antipsychotics are sparingly used for severe agitation or psychosis.
The biggest priority is preventing the complications of delirium. Immobility can lead to bedsores, blood clots and muscle wasting. Difficulty eating and drinking may cause malnutrition and dehydration.Inattention and disorientation also increase the risks of falls and injury. Careful nursing care and emotional support are vital.
While delirium typically lasts days to weeks, full recovery may take months. Persistent cognitive difficulties, anxiety and depression are common aftermaths. In the elderly, delirium can mark the onset of dementia. Recurrent delirium episodes lead to worse outcomes.
Early recognition, prompt treatment and vigilant care during delirious states are crucial for mitigating short and long-term risks. Educational efforts to increase awareness among families, caregivers and healthcare providers help improve the prevention, diagnosis and management of this complex neuropsychiatric syndrome impacting our vulnerable populations.