Delirium

Delirium is a mental disturbance that makes a person confused and a rreduction in the awareness of the environment.

It has a rapid onset ranging from a few hours to days. Factors that contribute to delirium include

• severe or chronic mental illness,
• metabolic imbalances,
• certain medication,
• infections,
• surgery or alcohol or drug withdrawal.

Some of the symptoms experienced in delirium are similar to those of dementia. This makes it harder for doctors to diagnose delirium.

Therefore, it is important for family members to provide necessary information to doctors to help with the diagnosis. There are three types of delirium.

They include:

Hyperactive delirium

It includes symptoms like restlessness, agitation, mood swings or hallucinations. This is the most easily tpe that is recognized.

Hypoactive delirium

This usually includes inactivity or reduced motor activity , sluggishness, abnormal drowsiness or seemimg to be in a daze.

Mixed delirium

Which includes the symptoms of both hypactive and hypoactive delirium. People with this type of delirium usually switch back and forth from the hypoactive and hypaeractive states.

The signs and symptoms of delirium tend to flactuate during the day and get worse at night.

In some cases, patients can have moments where they  do not experience any symptoms. Signs and symptoms include:

Reduced awareness of the environment

Signs of reduced awareness include;

• inability to focus on a topic or switch to a new topic,
• getting stuck on a topic,
• being easily distracted by unimportant things
• showing little or no response to the environment.

Poor thinking skills like poor memory

• Disorientation,
• difficulty talking, reading and writing
• trouble understanding speech.

Behaviour changes

• Hallucinations,
• restlessness,
• agitation,
• aggressive behaviour.

Some patients may become quiet and withdrawn and may experience sleeping disorders.

Emotional disturbances

• anxiety,
• paranoa,
• depression,
• euphoria,
• mood swings
• personality changes.

Disturbances in the normal sending and receiving of signals in the brain are the main causes of delirium.

Ths disorder can have a single or multiple causes. Other cases have no known cause and are refered to as idiopathic.

Some of the possible causes include:

• Drug toxicities
• Alcohol or drug abuse or withdrawal
• Certain medical conditions like chronic illnesses
• Metabolic imbalances
• Fever and acute infection especially in children
• Surgery
• Exposure to toxins
• Sleeping disorders

Doctors usually diagnose delirium based on a medical history of the patient, performing tests to evaluate mental status and identifying the possible causative factors.

Tests used include:

A mental status examination

In this test doctors assess a patient's awareness, attention or thinking. This is usually done through a conversation or screening teszts that assess mental state, confusion, perception and memory.

Physical and neurological exams

In which the doctor performs a physical exam to check for health problems or an uderlying illness and neurological exam to assess

• vision,
• balance,
• coordination
• reflexes.

This helps determine if any neurological disease is causing dilirium.

Other tests

Include blood and urine tests and brain imaging tests. Brain imaging tests are used when the available information is not enough for a diagnosis of delirium to be made.

The treatment of delirium is targetted towards the underlying cause. Treatments aim at creating an environment for healing and calming the brain.

Treatments available include:

Supportive care

This treatment aims at preventing complications. This can be achieved by:

• protecting the airway,
• providing fluids and nutrition,
• treating pain,
• assisting movement,
• avoiding use of physical restraints or bladder tubes,
• avoiding changes in the surroundings
• caregivers and encouraging family members to get involved.

Medications can be used to decrease pain in and to calm a patient. The drugs that are used are the dose is reduced or discontinued if delirium resolves.                                                                                                                                                                                                                                  

Avoiding factors that increase the risks of having delirium can be the most effective approach to preventing this disorder.

Promoting good sleeping petterns, helping the person remain calm and helping prevent other medical problems or complications of delirium can be helpful in reducing th severity of delirium.

Lifestyle modifications are necessary in order to cope with delirium.

The following steps can help improve the general health condition of a person with delirium:

• Promoting good sleeping habits
• Promoting calmness and good orientation.

This can be achieved by avoiding arguments and monitoring the noise levels of the environment.

• Preventing complications of delirium by giving proper medication on a regular schedule, increasing physical activity of the patient and providing a healthy diet with plenty of fluids.                                                                                                                                                                                                                                                                                                                                                                                                                                                    

Conditions that increase the risk of delirium include:

• Brain disorders like dementia, stroke and Parkinson's disease
• Older age
• Previous delirium episodes
• Visual or hearing impairement
• Having multiple medical condition

Some of the possible complications of delirium include:

• Overall decline in memory and thinking skills
• General decline in health
• Poor recovery from surgery
• Increased risk of death.

People with other medical conditions especially chronic diseases have a higher risk of developing complications while those in a better  state of health can recover fully.