Delirium: Causes, Symptoms & Treatment
Delirium is an acute confusional state characterized by sudden onset of disturbed consciousness, disorientation, and cognitive impairment, requiring immediate medical evaluation.
Things worth knowing about "Delirium"
Delirium is an acute confusional state characterized by sudden onset of disturbed consciousness, disorientation, and cognitive impairment, requiring immediate medical evaluation.
What is Delirium?
Delirium is an acute, usually reversible neuropsychiatric syndrome characterized by a sudden onset of disturbed consciousness, disorientation, impaired attention, and cognitive dysfunction. Symptoms typically develop over hours to days and often fluctuate in severity throughout the day. Delirium is a medical emergency that requires prompt diagnosis and treatment.
Causes
Delirium can be triggered by a wide range of underlying conditions. The most common causes include:
- Infections: e.g., urinary tract infections, pneumonia, sepsis
- Medications: anticholinergics, opioids, benzodiazepines, polypharmacy
- Withdrawal: alcohol or medication withdrawal (e.g., delirium tremens)
- Metabolic disturbances: electrolyte imbalances, renal failure, liver failure, hypoglycemia
- Neurological conditions: stroke, traumatic brain injury, epilepsy
- Surgery: postoperative delirium, particularly in older patients
- Dehydration and malnutrition
- Severe pain
Symptoms
Symptoms of delirium may vary depending on the subtype. Three main subtypes are recognized: hyperactive (agitated), hypoactive (quiet), and mixed delirium.
- Sudden confusion and disorientation (to time, place, or person)
- Impaired attention and distractibility
- Altered level of consciousness (ranging from drowsiness to agitation)
- Perceptual disturbances: hallucinations, illusions
- Disorganized thinking, incoherence, delusions
- Reversal of the sleep-wake cycle
- Emotional instability: fear, restlessness, depression
- Changes in speech and language
Diagnosis
Delirium is diagnosed clinically, supported by standardized assessment tools. The primary goal is to identify and address the underlying cause.
Clinical Assessment Tools
- CAM (Confusion Assessment Method): the most widely used screening tool
- CAM-ICU: adapted version for intensive care unit patients
- DSM-5 criteria: the diagnostic standard of the American Psychiatric Association
Diagnostic Investigations
- Blood tests (electrolytes, inflammatory markers, renal and liver function, blood glucose)
- Urinalysis
- Imaging (CT or MRI of the brain if a neurological cause is suspected)
- EEG if epileptic activity is suspected
- Medication review
Treatment
Treatment of delirium primarily aims to identify and correct the underlying cause, alongside supportive care measures.
Non-Pharmacological Measures
- Orientation aids: familiar people, clocks, calendars
- Frequent reorientation by caregivers and staff
- Optimizing the sleep environment
- Early mobilization
- Adequate hydration
- Avoiding immobility and unnecessary catheterization
Pharmacological Measures
- Antipsychotics (e.g., haloperidol) for severe agitation or hallucinations, used with caution
- Benzodiazepines for alcohol or benzodiazepine withdrawal delirium
- Treatment of the underlying condition (e.g., antibiotics for infection)
Risk Groups and Prevention
Those at greatest risk include older adults, patients with pre-existing dementia, post-surgical patients, and critically ill patients in intensive care. Preventive strategies include early mobilization, cognitive stimulation, adequate hydration, and careful medication review.
References
- American Psychiatric Association (APA) - Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5), 2013
- Inouye SK et al. - Delirium in elderly people. The Lancet, 383(9920):911-922, 2014. PubMed PMID: 23992774
- World Health Organization (WHO) - ICD-11: Mental and Behavioural Disorders - Delirium. Available at: https://icd.who.int
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