Definition

Delirium is a change in mental status. Delirium is marked by extreme, fluctuating changes, including:

    
  • Changes in perception and sensation
  • Difficulties with ability to:     
  • Focus
  • Sustain and shift attention
  • Think and reason rationally
  • Function normally
  • Communicate clearly
  • Causes

    Hundreds of underlying causes can result in delirium. Some of the most common causes include:

        
  • Serious medical condition such as a brain tumor, cancer, kidney failure, heart attack, stroke, seizures, and low or high blood sugar levels
  • Serious infections such as meningitis, pneumonia, and urinary tract infections
  • Toxic effects of medications
  • Injury such as severe head injury, broken bone, and severe pain
  • Alcohol or drug abuse
  • Withdrawal from alcohol or drug abuse
  • Toxins
  • Brain Tumor

    Brain Tumor

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    Risk Factors

    Factors that may increase your risk of developing delirium include:

        
  • Terminal illness, especially just before death
  • Serious illness such as AIDS
  • Increased age
  • Severe sleep deprivation
  • Severe burn
  • Central nervous system problems such as stroke , seizures , tumors and dementia
  • Surgery
  • Hospitalization
  • Visual or hearing impairment
  • Immobility
  • Dehydration
  • Severe constipation
  • Memory impairment
  • Deficiency in certain vitamins
  • Symptoms

    Symptoms usually come on quickly and can last for days, weeks, or longer. They also vary in severity depending on the cause. Symptoms are often worse at night and may include:

        
  • Inability to pay attention
  • Confusion
  • Memory problems
  • Language disturbances
  • Disorientation, especially about:     
  • Time of day
  • Where one is
  • Who one is
  • Severe symptoms include:

        
  • Misinterpretations—for example, thinking a doctor who is trying to help you is trying to hurt you
  • Illusions—for example, thinking someone is someone else
  • Hallucinations—seeing, hearing, or feeling things that are not there
  • Emotional disturbances—for example, suddenly becoming angry, fearful, or withdrawn for no apparent reason
  • Diagnosis

    You will be asked about your symptoms and medical history. A physical exam will be done. The doctor will ask specific questions about:

        
  • Present injury or illness
  • Use of medications or illicit drugs
  • Time when mental state changed
  • How and how fast the mental state changed
  • The diagnosis will be made based on what the doctor finds during the exam. To determine a cause your doctor may need to run several tests such as:

        
  • Blood tests
  • Urine tests
  • Spinal tap
  • Kidney and liver function tests
  • Thyroid function tests
  • Images of internal organs may also help to determine a cause. Images may be taken with:

        
  • Chest x-ray
  • Electrocardiogram (ECG)
  • CT scan
  • MRI scan
  • Electroencephalogram (EEG)—to look for evidence of seizures
  • Treatment

    Delirium is first treated by identifying and treating the underlying cause. Then, symptoms are treated through medication, psychological management, and environmental and supportive intervention.

    Treatments may include:

    Medication

    Drugs used to treat symptoms of delirium include:

        
  • High potency antipsychotic medications
  • Benzodiazepines—used to treat delirium caused by alcohol withdrawal
  • Cholinergic medications—used to treat delirium caused by anticholinergic medications, which are used to treat stomach cramps and spasms in the intestines and bladder, among other conditions
  • Vitamins—given if the delirium is caused by low levels of vitamins
  • If you are taking medication that is worsening your confusion, you may be asked to stop these.

    Psychological Management

    Psychological therapy may help you:

        
  • Feel safer and more comfortable
  • Improve the ability to function
  • Calm down and feel less anxious
  • Environmental and Supportive Intervention

    This type of treatment can be done by doctors, nurses, or caretakers. It can help you readjust to your surroundings and reduce anxiety. Examples of this intervention include:

        
  • Placing a clock and calendar in your room.
  • Darkening the room at night and providing natural light during the day time hours.
  • Maintaining a quiet, noise-free room.
  • Reminding you often of the day and time, where you are, and why you are there.
  • Placing familiar objects around you such as family photographs or objects from home.
  • Prevention

    A number of steps have been shown to help prevent delirium in hospitalized patients at risk for delirium. These steps include:

        
  • Using memory orientation aids
  • Listening to relaxation tapes
  • Doing light exercise—when possible and if advised by your doctor
  • Using vision and hearing aids when necessary
  • Drinking plenty of fluids to prevent dehydration
  • Delirium is difficult to prevent because it has so many causes and it can come on suddenly.