Delirium
Delirium
Delirium
DDelirium, or a state of acute mental confusion, is a syndrome that displays a varying lack of attention, awareness, and cognitive mental processes such as thinking, reasoning, remembering, imagining, or learning. Delirium develops quickly — in hours or days. This sudden reduced awareness of one’s surroundings and confused thinking is a critical interference with a person’s mental capacity and function.
Delirium is an interruption or impairment in the sending and receiving of signals or information in the brain, which makes it vulnerable and can result in the malfunction of normal brain functions.
Where possible, a doctor may solicit input from caregivers or family members to accurately diagnose the condition, since delirium and dementia have similar symptoms.
It is not uncommon for the associated hallucinations to be frightening and/or bizarre where the person sees people or things which aren’t there. This can become particularly unsettling if additional symptoms like paranoia or delusions appear at the same time.
Each person’s response to the condition will vary, and while some might physically pace the floor, be agitated or restless and irritable, others may withdraw and become quiet, which can conceal the condition or the symptom, and another group of individuals will have a mix of both responses.
Prevalence
Of all general admissions to hospital, between 15 and 20% of patients experience delirium, with a higher frequency in the elderly, and especially those with preexisting conditions.
Duration
The duration of delirium can last from only a few hours to as long as several weeks or even months.
Dementia vs Delirium
Individuals who have dementia can see a higher frequency of occurrence of delirium. This presents challenges since the two conditions can be somewhat difficult to tell apart when looking at symptoms.
Dementia and delirium symptom differences include:
| DELIRIUM | DEMENTIA |
|---|---|
| ONSET – Delirium onset occurs in a very short timeframe, and with noticeable symptoms. | ONSET – Dementia starts out with symptoms that are not as easily noticed at first, and then they get worse slowly over time because of the gradual deterioration and eventual malfunction of brain cells. |
| FOCUS – Delirium presents significantly greater challenges in relation to maintaining attention or staying focused. | FOCUS – An individual just beginning to experience symptoms of dementia would generally be considered to be alert and able to focus. |
| FLUCTUATION – With delirium, the symptoms fluctuate enough to be noticeable. Depending on the cause and the severity, the condition can last anywhere from a few hours to a few days, or longer. | FLUCTUATION– With dementia, people may experience better or worse times throughout the day, but their cognitive skills and memory recall generally don’t noticeably fluctuate. |
DDelirium, or a state of acute mental confusion, is a syndrome that displays a varying lack of attention, awareness, and cognitive mental processes such as thinking, reasoning, remembering, imagining, or learning. Delirium develops quickly — in hours or days. This sudden reduced awareness of one’s surroundings and confused thinking is a critical interference with a person’s mental capacity and function.
Delirium is an interruption or impairment in the sending and receiving of signals or information in the brain, which makes it vulnerable and can result in the malfunction of normal brain functions.
Where possible, a doctor may solicit input from caregivers or family members to accurately diagnose the condition, since delirium and dementia have similar symptoms.
It is not uncommon for the associated hallucinations to be frightening and/or bizarre where the person sees people or things which aren’t there. This can become particularly unsettling if additional symptoms like paranoia or delusions appear at the same time.
Each person’s response to the condition will vary, and while some might physically pace the floor, be agitated or restless and irritable, others may withdraw and become quiet, which can conceal the condition or the symptom, and another group of individuals will have a mix of both responses.
Prevalence
Of all general admissions to hospital, between 15 and 20% of patients experience delirium, with a higher frequency in the elderly, and especially those with preexisting conditions.
Duration
The duration of delirium can last from only a few hours to as long as several weeks or even months.
Dementia vs Delirium
Individuals who have dementia can see a higher frequency of occurrence of delirium. This presents challenges since the two conditions can be somewhat difficult to tell apart when looking at symptoms.
Symptom differences include:
DEMENTIA
DELIRIUM
Symptoms of Delirium:
People with delirium are impacted by the condition to different degrees, but for some, it can bear similarities to someone who is in the process of becoming increasingly intoxicated. The hallmark of the condition is the reduction or elimination of a person’s ability to pay attention.
Individuals with delirium experience its effects in sleep patterns, muscle control, emotions, and the mind.
The severity of the condition may fluctuate within a few minutes or over the course of a few hours, resulting in varying levels of awareness — being alert for a period and suddenly confused, sluggish, or drowsy. For some people, they may experience a phenomenon called sundowning, where their symptoms change often within minutes and progress in their severity over the course of an evening.
Causes of Delirium:
Underlying and reversible changes in the structure, role, and chemical makeup of the body and/or brain can cause delirium. The disease process might happen outside of the brain but still involve the brain.
When significant predisposition exists, and there are repeated interactions with factors known to be triggers, the likelihood of delirium occurring is much higher.
Delirium is often brought about by:
*Medications have been shown to be responsible for delirium in 20% to 40% of cases, but narcotics, benzodiazepines, and drugs that have anticholinergic activity are among the highest offenders. Drugs, medication, or medication combination-related causes can include:
Changes can be made to reduce the risk of experiencing symptoms of delirium through reducing or eliminating the prescription of, or exposure to, those meds representing the highest risk.
Being withdrawn and drowsy is common in people who have developed delirium after taking sedatives. When the cause isn’t identified and treated quickly, individuals may exhibit increasing drowsiness and eventually become unresponsive, and in some cases, this stupor can result in a coma or death.
Hyperactivity and aggression are common for people who have stopped taking sedatives or who may have taken amphetamines.
Risk Factors for Delirium
Nursing home residents, or those with medical conditions that require a hospital stay, and especially those needing time in intensive care or time in the hospital after a surgery, have a higher risk of developing delirium.
Risk factors for those having delirium fall into 3 main groups — patient factors, pharmacological factors, and environmental factors.
Diagnosing Delirium:
Often described as having a universal nature instead of distinct conditions, delirium has numerous synonyms including postoperative psychosis, acute confusional state, and acute brain failure.
There are three types of delirium:
- Hyperactive delirium – more easily recognizable than the other types, it can include agitation, restlessness, rapidly changing mood, pacing, and possibly hallucinations.
- Hypoactive delirium – This can present as sluggishness, inactivity, reduced motor activity, abnormal drowsiness, or the appearance of being dazed.
- Mixed delirium – This type has symptoms from both types, and the individual can alternate between the two types quickly.
Testing determines current mental status and identifies any possible known contributing factors. The patient’s medical history will also be used to determine a delirium diagnosis.
Treatment of Delirium:
In most cases, a predisposition combines with situations or events and aggravating elements that impact the course of delirium. Delirium studies have shown a possibility that a single case can have between 2 and 6 factors, therefore the discovery of each cause is essential to create the most suitable treatment plan.
When the condition causing delirium is quickly identified and the person gets the right treatment, the majority of people see a full recovery, but any delay will reduce the likelihood of this.
Treating delirium involves identifying and treating the underlying cause, which can include:
Through the reduction or elimination of various triggers like particular medications, or constantly changing caregiver staff, the triggers can be addressed significantly reducing the frequency or severity of occurrence, and then treatment will include the creation of a healing and calming environment.
Progress depends on the individual, their triggers, the severity of the resulting symptoms, and how quickly and effectively it is treated. Some symptoms can persist for a number of weeks or months, and progress could be slow. For some patients, delirium can devolve into a chronic dysfunction of the brain like dementia.
Medications for Delirium:
In addition to pain management, the doctor may suggest some medication to reduce anxiety for people who get confused by their surroundings and start experiencing severe fear, paranoia, or hallucinations — which could all lead to extreme agitation.
Situations where this type of medication may be needed is for cases where the individual’s behavior:
- Makes medical treatment or exams impossible
- Puts the individual or others’ safety at risk
- Is not improving with treatments that don’t involve medication
Some medications that are required for other conditions or ailments could be triggering delirium and may need to be reduced or stopped, and there is also the potential that some medication might need to be added to reduce or control any pain, if the pain is a trigger for delirium.
Coping with Delirium:
As a caregiver to someone with delirium, you may be able to help improve their health and help prevent another episode with some focused effort in the following areas:
Healthy sleep habits
Help them remain calm
Prevent medical problems
Provide care for the caregiver
Being a caregiver for someone with delirium can be very tiring, and for some a potential source of anxiety. In order to look after yourself, and to remain able to give the best care, it is important to take care of yourself as well. Consider the following:
Delirium Complications:
Delirium can have serious complications such as:
People who experience delirium are also more vulnerable to developing dementia in later life.
People with delirium who become hospitalized (especially elderly patients) have more expensive treatment costs, longer recovery times, and an increased risk for the development of additional complications. Between 35 to 40% of those with delirium while hospitalized die in under 12 months from conditions other than delirium.
Complications include:
Symptoms of Delirium:
People with delirium are impacted by the condition to different degrees, but for some, it can bear similarities to someone who is in the process of becoming increasingly intoxicated. The hallmark of the condition is the reduction or elimination of a person’s ability to pay attention.
Individuals with delirium experience its effects in sleep patterns, muscle control, emotions, and the mind.
The severity of the condition may fluctuate within a few minutes or over the course of a few hours, resulting in varying levels of awareness — being alert for a period and suddenly confused, sluggish, or drowsy. For some people, they may experience a phenomenon called sundowning, where their symptoms change often within minutes and progress in their severity over the course of an evening.
Causes of Delirium:
Underlying and reversible changes in the structure, role, and chemical makeup of the body and/or brain can cause delirium. The disease process might happen outside of the brain but still involve the brain.
When significant predisposition exists, and there are repeated interactions with factors known to be triggers, the likelihood of delirium occurring is much higher.
Delirium is often brought about by:
*Medications have been shown to be responsible for delirium in 20% to 40% of cases, but narcotics, benzodiazepines, and drugs that have anticholinergic activity are among the highest offenders. Drugs, medication, or medication combination-related causes can include:
Changes can be made to reduce the risk of experiencing symptoms of delirium through reducing or eliminating the prescription of, or exposure to, those meds representing the highest risk.
Being withdrawn and drowsy is common in people who have developed delirium after taking sedatives. When the cause isn’t identified and treated quickly, individuals may exhibit increasing drowsiness and eventually become unresponsive, and in some cases, this stupor can result in a coma or death.
Hyperactivity and aggression are common for people who have stopped taking sedatives or who may have taken amphetamines.
Risk Factors for Delirium:
Nursing home residents, or those with medical conditions that require a hospital stay, and especially those needing time in intensive care or time in the hospital after a surgery, have a higher risk of developing delirium.
Risk factors for those having delirium fall into 3 main groups — patient factors, pharmacological factors, and environmental factors.
Diagnosing Delirium:
Often described as having a universal nature instead of distinct conditions, delirium has numerous synonyms including postoperative psychosis, acute confusional state, and acute brain failure.
There are three types of delirium:
- Hyperactive delirium – more easily recognizable than the other types, it can include agitation, restlessness, rapidly changing mood, pacing, and possibly hallucinations.
- Hypoactive delirium – This can present as sluggishness, inactivity, reduced motor activity, abnormal drowsiness, or the appearance of being dazed.
- Mixed delirium – This type has symptoms from both types, and the individual can alternate between the two types quickly.
Testing determines current mental status and identifies any possible known contributing factors. The patient’s medical history will also be used to determine a delirium diagnosis.
Treatment of Delirium:
In most cases, a predisposition combines with situations or events and aggravating elements that impact the course of delirium. Delirium studies have shown a possibility that a single case can have between 2 and 6 factors, therefore the discovery of each cause is essential to create the most suitable treatment plan.
When the condition causing delirium is quickly identified and the person gets the right treatment, the majority of people see a full recovery, but any delay will reduce the likelihood of this.
Treating delirium involves identifying and treating the underlying cause, which can include:
Through the reduction or elimination of various triggers like particular medications, or constantly changing caregiver staff, the triggers can be addressed significantly reducing the frequency or severity of occurrence, and then treatment will include the creation of a healing and calming environment.
Progress depends on the individual, their triggers, the severity of the resulting symptoms, and how quickly and effectively it is treated. Some symptoms can persist for a number of weeks or months, and progress could be slow. For some patients, delirium can devolve into a chronic dysfunction of the brain like dementia.
Medications for Delirium:
In addition to pain management, the doctor may suggest some medication to reduce anxiety for people who get confused by their surroundings and start experiencing severe fear, paranoia, or hallucinations — which could all lead to extreme agitation.
Situations where this type of medication may be needed is for cases where the individual’s behavior:
- Makes medical treatment or exams impossible
- Puts the individual or others’ safety at risk
- Is not improving with treatments that don’t involve medication
Some medications that are required for other conditions or ailments could be triggering delirium and may need to be reduced or stopped, and there is also the potential that some medication might need to be added to reduce or control any pain, if the pain is a trigger for delirium.
Coping with Delirium:
As a caregiver to someone with delirium, you may be able to help improve their health and help prevent another episode with some focused effort in the following areas:
Healthy sleep habits
Help them remain calm
Prevent medical problems
Provide care for the caregiver
Being a caregiver for someone with delirium can be very tiring, and for some a potential source of anxiety. In order to look after yourself, and to remain able to give the best care, it is important to take care of yourself as well. Consider the following:
Delirium Complications:
Delirium can have serious complications such as:
People who experience delirium are also more vulnerable to developing dementia in later life.
People with delirium who become hospitalized (especially elderly patients) have more expensive treatment costs, longer recovery times, and an increased risk for the development of additional complications. Between 35 to 40% of those with delirium while hospitalized die in under 12 months from conditions other than delirium.
Complications include: