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Delirium is a disorder of consciousness characterized by a sense of confusion in time and space, difficulty maintaining attention, impaired intellectual function, and the occurrence of hallucinations. It can be a consequence of a physical illness, sudden discontinuation of drugs or psychoactive substances or intoxication with them. See what the causes of delirium syndrome are and how to deal with a patient who is delirious.

Delirium (delirium, delirium)is a periodic and transient brain disorder. It most often develops in the elderly (over 65 years of age), in people suffering from severe somatic diseases, who take large amounts of drugs or psychoactive substances. Symptoms of delirium are also diagnosed in patients who have undergone surgery under anesthesia (they may persist for up to 4 days after the surgery).

Delirium (delirium) - symptoms

A patient who may be suspected of delirium exhibits the following symptoms:

  • confusion in time and space- the patient cannot answer the question about the date, time or place; confusion about oneself is less frequent (e.g. difficulties with finding out who I am, what my name is, etc.);
  • hallucinations- false sensory perceptions perceived by the patient as existing. It can be seeing imaginary people, animals, insects, hearing voices and sounds that do not exist; touch and smell hallucinations are less frequent;
  • intellectual impairment- slow thinking, clearly weakened concentration, difficulties with building logical statements, answering the simplest questions, memory impairment;
  • increased level of anxiety- the patient feels anxiety, fear, may be aggressive;
  • mood swings and changes in psychomotor activity- the patient is apathetic, depressed, sleepy, sometimes euphoric, over-aroused;
  • sleep-wake rhythm disturbances- insomnia at night and excessive daytime sleepiness.

Delirium (delirium) - causes

Delirium rarely has only one cause. This is usually due to several overlapping factors, especially in the case of older people.Old age significantly increases the risk of delirium - the reason is the progressive damage to the brain structures in people over 60 years of age. As a result, irreversible disturbances of the brain activity arise, which may additionally intensify in the course of somatic diseases characteristic of old age.

Diseases that may contribute to the occurrence of delirium are:

  • problems with the circulatory system (hypertension, arrhythmias, circulatory failure, heart attack)
  • diabetes
  • liver and kidney failure
  • respiratory failure
  • anemia
  • neurological diseases (epilepsy, Alzheimer's disease)
  • water and electrolyte disturbances (dehydration)
  • inflammation and infectious conditions (tuberculosis, mumps, toxoplasmosis, mycosis, HIV, syphilis, cytomegaly)
  • brain diseases (tumors, hematomas, strokes and injuries of the brain)
  • infections, especially those with high fever
  • autoimmune diseases (Hashimoto's disease, systemic lupus, rheumatoid arthritis)

Apart from old age and somatic diseases, another very common cause of delirium is intoxication with drugs or psychoactive substances. This applies in particular to sleeping pills, antidepressants and drugs, which, when abused, lead to hypoxia of the brain and, consequently, the appearance of hallucinations.

In addition, delirium can occur in people who are exposed to increased contact with strong chemicals: heavy metals, insecticides, volatile substances such as solvents and gasoline. It is also a symptom of poisoning with carbon dioxide and carbon monoxide.

Worth knowing

Delirium tremens - alcoholic delirium

Delirium tremens is a special type of delirium in alcoholics who suddenly stop drinking. On the 2-3rd day after stopping alcohol completely, they develop severe convulsions, confusion about the time and place of being, anxiety, anxiety, insomnia, visual, auditory and tactile delusions. These symptoms are often accompanied by increased body temperature, dehydration, and disturbances in the work of the circulatory system.

People who have had several years of regular drinking behind them are the most vulnerable to delirium tremens. Symptoms of tremor delirium last for several days and require treatment in a hospital.

Delirium (delirium) - how long does it last?

The symptoms of delirium are temporary and vary in severity. If they are a direct consequence of a physical illness (e.g. infection with fever), they disappear with recoverypatient. In this case, delirium lasts from several hours to several days. Symptoms worsen in the afternoon and evening hours.

In the elderly, delirium may be episodic (e.g. after surgery in a hospital), but also coexist with dementia. Symptoms that predict delirium in seniors are restlessness, anxiety, sleep problems, nightmares, and mood swings. After a few days, the patient's condition worsens - perception disorders appear, motor agitation increases, alternating with states of apathy and dementia. The final stage of delirium is the gradual resolution of disorientation symptoms - the patient regains clarity of thinking and the ability to remember. The total duration of the disorder is 10-12 days.

How to deal with a delirious patient?

A person affected by delirium may behave irrationally and endanger himself or the environment. Therefore, when symptoms of delirium occur, she should be under constant care and appropriate conditions in the room in which she stays. In order for the patient to better orientate himself in time, it is worth setting the clock in a visible place and revealing the windows. You should also talk to him as much as possible so that he does not forget where he is and who the people around him are. It is also necessary to ensure that the patient has enough fluids, because dehydration is an additional factor exacerbating the course of delirium. In the case of aggressive behavior, the caregiver should not raise his voice, but slowly and clearly explain the patient's condition and keep calming him down.

Delirium (delirium) - treatment

Treatment of delirium resulting from a somatic disease is to remove the causes of the underlying disease - for example, in the case of dehydration, it will be fluid and electrolyte replenishment, and in case of fever, administering antipyretic drugs.

If the disturbance of consciousness is rapid, the patient is aggressive, agitated, additionally sedatives and anxiolytics are used. Elderly people who experience frequent delirium and are therefore at risk of developing psychosis are given antipsychotics.

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Category:

Psychiatry