Delirium

Generality

Delirium, or delirium, is a serious disturbance of mental abilities and thinking, on which an acute confusional state depends, a reduction of awareness related to the surrounding environment, anomalous behaviors and, finally, the deficit of some cognitive abilities.

The causes of delirium are numerous; among these, we point out: the abuse of alcohol or drugs, the presence of a terminal illness, hospitalization in intensive care, malnutrition, the presence of some metabolic imbalance, stroke, myocardial infarction, the severe hypoglycemia, sleep deprivation, the body's exposure to a powerful toxin, schizophrenia and psychosis.

Generally, the symptoms of delirium appear within a few hours.

For a correct diagnosis of delirium and of the triggering causes, the following are fundamental: physical examination, medical history, a neurological evaluation, an evaluation of the psychic profile and a series of laboratory tests.

The treatment of delirium mainly concerns the treatment of triggering causes; triggers that also determine whether the prognosis is positive or not.

What is delusion?

Delirium is a serious disturbance of mental abilities and thought, generally sudden onset, which involves, above all, a confusion and a reduction in the awareness of the surrounding environment.

In medicine, delirium is also known as an acute confusional state or delirium .

Causes

Based on reliable neurological studies, the onset of delirium depends on a malfunction of brain activity, such that the mechanisms of transmission of nerve impulses entering and leaving the brain are altered.

Several factors can cause the malfunctioning of the brain activity that characterizes delirium, including:

Abuse or dependence on certain drugs or alcohol;
Some special medical conditions, such as stroke, TIA, myocardial infarction, severe brain trauma, arrhythmias, hypoglycemia or urinary retention;
The presence of some metabolic imbalance, such as hypocalcemia or hyposodemia;
The presence of a serious chronic illness (eg: Addison's disease) or a terminal illness (eg, malignant tumor);
The body's exposure to a powerful toxin;
Malnutrition or dehydration;
The presence of a serious infection of the urinary tract or respiratory tract;
Sleep deprivation;
Persistent constipation;
A serious emotional stress;
The presence of a very strong pain;
The after-effects of anesthesia practiced during a major surgery;
Hospitalization in intensive care. In these situations, doctors speak of "delirium in intensive care";
Schizophrenia, psychosis or bipolar disorder;
Dementias such as Alzheimer's disease or vascular dementia;
Excessive intake of certain drugs or their inappropriate combination. Among the drugs that, if used incorrectly, can cause delirium, include: the most powerful painkillers, medicines to promote sleep, anxiolytics, antidepressants, antihistamines, medicines for Parkinson's disease, anticonvulsants and medicines against asthma.

RISK FACTORS

Numerous clinical studies have shown that the risk of developing a form of delirium is greater in:

People of advanced age. Old age is, perhaps, the most important risk factor of delirium;
Those who have a propensity to consume alcohol or drugs;
Those who make indiscriminate use of drugs;
People who cannot or do not want to eat adequately and according to the needs of their organism;
Those who have a certain psychic fragility;
Those who suffer from visual or hearing impairment;
People with those neurological disorders that, typically, precede dementias (eg: mild cognitive disorder);
Those who are forced to a long period of hospitalization, especially in intensive care;
People suffering from a serious illness and, therefore, in serious danger of life;
Those who have been victims of violent blows to the head.

Epidemiology

Interesting statistical surveys have shown that delirium has the highest incidence rate among people admitted to intensive care. The numbers in this regard speak of 50-75% of patients, so half and even more.

What triggers delirium in people undergoing intensive care?

Doctors believe that delirium in people in intensive care depends on a combination of factors, including: the presence of a serious health condition (which is why the patient is hospitalized in intensive care), the administration of large doses of different drugs and mechanical ventilation.

Symptoms, signs and complications

In general, the symptoms and signs of delirium appear within a few hours and fluctuate throughout the day (in the sense that they alternate moments of particular intensity with moments of apparent absence).

In most patients, the symptoms undergo a drastic deterioration with the darkness of the night, when the ability to recognize the surrounding environment is reduced for obvious reasons.

Going into the details of clinical manifestations, delirium has mainly 4 consequences:

Reduces awareness of the surrounding environment .
Witness a drop in awareness of the surrounding environment:

The inability to concentrate on one topic and the inability to move quickly from one topic to another;
Failure to answer direct questions or failure to participate in conversations;
Fixing on a certain idea or topic, even when the topic of discussion has changed;
The absence of will to participate in any activity.

It affects cognitive abilities .
They are evidence of a worsening of cognitive abilities:

Poor memory, especially for recent events;
Disorientation;
The language difficulties;
The meaningless speeches;
The difficulties in understanding what others say;
The difficulties of writing and reading.

Induces behavioral abnormalities .
Among the possible behavioral anomalies that characterize delirium, we note:

Hallucinations;
Restlessness, agitation and aggression for no reason;
The emission of sounds or groans for no reason;
The tranquility end (typical of elderly patients);
Lethargy, drowsiness and slow movements;
The alteration of the sleep-wake cycle.

Produces serious emotional disorders .
Some of the possible emotional disorders related to the presence of delirium are:

Anxiety, fear without reason and paranoia;
The Depression;
Irritability or anger;
A state of inexplicable euphoria;
Apathy;
The mood swings.

TYPES OF DELIRIUM

Delirium is not always responsible for the same symptomatology in all patients.

For this reason, the experts considered it appropriate to distinguish three types of delirium:

The hyperactive delirium . Easily recognizable, it is characterized by restlessness, agitation, rapid mood changes and / or hallucinations.
Hypoactive delirium . It is characterized by a tendency to inactivity, slowness in movement, drowsiness and / or lethargy.
The mixed delirium . Includes the symptoms of hyperactive delirium and hypoactive delirium. In other words, those affected can suddenly pass from a state of restlessness to lethargy, etc.

DELIRIUM AND DEMENTIA: THE DIFFERENCES

Delirium and dementia are two similar medical conditions, in terms of symptoms, and sometimes linked by a consequential link (some forms of dementia cause delirium).

However, they are extremely different, as far as the triggering mechanism is concerned. In fact, while at the basis of delirium there is an alteration of potentially reversible brain activity, at the origin of dementia there is an irreversible degeneration of brain cells.

How to distinguish delirium from a form of dementia, in an individual not affected by it

Delirium and dementia differ, principally, from three points of view: onset, attention span and symptom fluctuation.

Onset : delirium appears very quickly (a few hours), while dementia occurs very slowly (it could take up to several years for their obvious manifestation).
Attention capacity : a person with delirium immediately has reduced attention span, while a person with dementia remains alert at least for the entire initial phase of the disease.
Fluctuation of symptoms : in delirium, symptoms fluctuate easily and repeatedly over the same day; in dementia, on the other hand, the symptoms fluctuate more rarely and are constant for several days.

COMPLICATIONS

Delusion is not in itself a source of complications; it can become, however, when it depends on a serious health condition.

A form of delirium associated with a serious health condition may necessitate continued assistance from specific personnel, further impair the patient's quality of life and, in some situations, even pose a risk to life.

Diagnosis

In general, the procedure for diagnostic tests to identify delirium and its causes includes: physical examination, medical history, neurological evaluation, mental status assessment and a series of laboratory tests (ex: urine tests, blood tests, etc.).

The diagnosis of delirium is not always simple and immediate, since the condition in question has several symptomatic analogies with the aforementioned dementia, psychosis, some forms of depression and certain congenital dysfunctions of the brain.

IMPORTANCE OF ACCURATE DIAGNOSIS OF CAUSES

The precise identification of the causes of delirium is extremely important, as it is the starting point for the most appropriate therapy planning.

Therapy

The treatment of delirium is based, mainly, on causal therapy, that is on the treatment of the triggering causes .

Secondly, it provides a supportive therapy, whose goal is to promote the brain health of patients.

EXAMPLES OF CAUSAL THERAPIES

Some examples of causal therapy for delirium are:

The interruption of any pharmacological assumption, in the case in which the delirium depended on an improper use of drugs;
An ad hoc antibiotic therapy, in the event that the delirium resulted from a bacterial infection of the urinary tract or respiratory tract;
A dietary plan appropriate to the needs of the patient, in the event that the delirium derives from a serious state of malnutrition;
Alcohol detoxification, in the event that delirium was the consequence of an alcohol addiction.

The effectiveness of causal therapy depends on the treatability of the triggering factors: it is obvious that the more a cause is treatable, the better the effects of the causal treatment practiced; vice versa, the less treatable it is a cause, the less the therapeutic effects of the causal treatment realized.

SUPPORT THERAPY

They are indispensable to the well-being of the brain of patients suffering from delirium: the right supply of oxygen, proper hydration, proper nutrition and the maintenance of adequate levels of circulating metabolites in the body.

Providing good brain health in many cases optimizes the effect of causal therapy.

ARE THERE MEDICINES AGAINST THE DELIRIUM?

Currently, there is no specific drug for delirium.

However, it is worth noting that, in the presence of symptoms such as paranoia, hallucinations and / or agitation, the use of antipsychotics on patients suffering from delirium often has a calming effect.

SOME EXPERT ADVICE

According to doctors and experts, those who are overcoming a form of delirium are of benefit: a regular nighttime sleep, the performance of moderate physical activity (clearly when health conditions allow), the maintenance of calm, the frequentation of environments comfortable and relaxing, knowledge of the disorder that afflicts them, attending support groups for people with similar problems, and support from family and close friends.

Prognosis

The prognosis in case of delirium depends on the triggering causes.

In fact, if the triggering factors are treatable, there is a good chance that the delirium will resolve and the prognosis is positive. On the other hand, if the triggering factors are hardly treatable, delirium tends to remain so, if not even worse in its manifestations.