Delirium is a state of mental confusion that develops quickly and usually fluctuates in intensity.
Description
Delirium is a syndrome, or group of symptoms, caused by a disturbance in the normal functioning of the brain. The delirious patient has a reduced awareness of and responsiveness to the environment, which may be manifested as disorientation, incoherence, and memory disturbance. Delirium is often marked by hallucinations, delusions, and a dream-like state.
Delirium affects at least one in 10 hospitalized patients, and is a common part of many terminal illnesses. Delirium is more common in the elderly than in the general population. While it is not a specific disease itself, patients with delirium usually fare worse than those with the same illness who do not have delirium.
Causes
There are a large number of possible causes of delirium. Metabolic disorders are the single most common cause, accounting for 20–40% of all cases. This type of delirium, termed "metabolic encephalopathy," may result from organ failure, including liver or kidney failure. Other metabolic causes include diabetes mellitus, hyperthyroidism and hypothyroidism, vitamin deficiencies, and imbalances of fluids and electrolytes in the blood. Severe dehydration can also cause delirium.
Drug intoxication ("intoxication confusional state") is responsible for up to 20% of delirium cases, either from side effects, overdose, or deliberate ingestion of a mind-altering substance. Medicinal drugs with delirium as a possible side effect or result of overdose include:
Drug withdrawal may also cause delirium. Delirium tremens, or "DTs," may occur during alcohol withdrawal after prolonged or intense consumption. Withdrawal symptoms are also possible from many of the psychoactive prescription drugs.
Poisons may cause delirium ("toxic encephalopathy"), including:
solvents, such as gasoline, kerosene, turpentine, benzene, and alcohols
The symptoms of delirium come on quickly, in hours or days, in contrast to those of dementia, which develop much more slowly. Delirium symptoms typically fluctuate through the day, with periods of relative calm and lucidity alternating with periods of florid delirium. The hallmark of delirium is a fluctuating level of consciousness. Symptoms may include:
Treatment of delirium begins with recognizing and treating the underlying cause. Delirium itself is managed by reducing disturbing stimuli, or providing soothing ones; use of simple, clear language in communication; and reassurance, especially from family members. Physical restraints may be needed if the patient is a danger to himself or others, or if he insists on removing necessary medical equipment such as intravenous lines or monitors. Sedatives or antipsychotic drugs may be used to reduce anxiety, hallucinations, and delusions.
Prognosis
Persons with delirium usually have a worse prognosis for the underlying disease than the person without delirium. Nonetheless, those without terminal illness usually recover from delirium. They may not, however, regain all their original cognitive abilities, and may be left with some permanent impairments, including fatigue, irritability, difficulty concentrating, or mood changes.
Prevention
Prevention of delirium is focused on treating or avoiding its underlying causes. The most preventable forms are those induced by drugs. Strategies for reducing delirium include following prescriptions, consulting the prescribing physician immediately if symptoms occur, and consulting the physician before discontinuing the drug, even if it has been ineffective; avoiding intoxication with legal or illegal drugs, and seeking professional assistance before suddenly discontinuing an addictive drug such as alcohol or heroin; maintaining good nutrition, which promotes general health and can minimize the likelihood of delirium from alcohol intoxication and withdrawal; and avoiding exposure to solvents, insecticides, heavy metals, or biological poisons in the home or workplace.
BOOKS
Guze, Samuel, ed. Adult Psychiatry. Mosby Year Book, 1997.
Harrison's Principles of Internal Medicine. Ed. Anthony S. Fauci, et al. New York: McGraw-Hill, 1997.
Richard Robinson
KEY TERMS
Dementia—A loss of mental ability severe enough to interfere with functioning. While dementia and delirium have some of the same symptoms, dementia has a much slower onset.
Electroencephalogram (EEG)— A chart of the brain wave patterns picked up by electrodes placed on the scalp. This is useful for diagnosing central nervous system disorders.
