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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.

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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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