Definition

Delirium is a change in mental status. It usually comes on quickly, over hours or days. 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 (eg, brain tumor, cancer, kidney failure, heart attack, stroke, seizures, low or high blood sugar levels)
  • Serious infections (eg, meningitis, pneumonia, urinary tract infections )
  • Toxic effects of medicines
  • Injury (eg, severe head injury, broken bone, or severe pain )
  • Alcohol or drug abuse
  • Withdrawal from alcohol or drug abuse
  • Toxins
  • Brain Tumor

    Brain Tumor

    Just one of many potential causes of delirium.

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    Risk Factors

    These factors increase your chance of developing delirium:

        
  • Terminal illness, especially just before death
  • Serious illness such as AIDS
  • Advanced age
  • Severe sleep deprivation
  • Severe burn
  • Central nervous system problems such as stroke , seizures , tumors or 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  • Emotional disturbances—for example, suddenly becoming very angry, fearful, or withdrawn for no apparent reason
  • Diagnosis

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

        
  • Present injury or illness
  • Use of medicines 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 to:     
  • Look for signs of infection
  • Examine electrolyte levels including sodium , potassium , and calcium
  • Determine oxygen levels in the blood
  • Determine blood glucose levels
  • Determine Level of vitamins such as vitamin B12 , folate , and thiamine
  • Assess the level of medication in the blood
  • Look for toxins or illicit drugs
  • Kidney and liver function tests
  • Thyroid function tests
  • Spinal tap —to look for signs of infection, inflammation, injury, and/or cancer in the brain or spine
  • Urine examination and culture—to look for signs of infection
  • Images of internal organs may also help to determine a cause. Images may be taken with:

        
  • Chest x-ray to look for pneumonia
  • Electrocardiogram (ECG)—to examine the heart's electrical activity for evidence of heart disease
  • 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 medicine, psychological management, and environmental and supportive intervention.

    Treatments may include:

    Medication

    Drugs used to treat symptoms of delirium include:

        
  • High potency antipsychotic medicines
  • Benzodiazepines—used to treat delirium caused by alcohol withdrawal
  • Cholinergic medicines—used to treat delirium caused by anticholinergic medicines, 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 reducing 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 very light exercise (when possible and if recommended 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.