Delirium – causes, symptoms, diagnosis and treatment [EXPLAINED]

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Delirium is most often associated with patients who, after a long time of alcohol abuse, decided to suddenly stop drinking alcohol. As it turns out, delirium is a common neurocognitive disorder that develops in a significant part of the elderly society. What should you know about delirium?

The features that are most often defined as delirium are consciousness disorders and attention disorders. When consciousness is disturbed, the patient feels confused both in time and in space. On the other hand, attention disorders consist in impaired ability to concentrate.

Delirium cannot be called a mental illness. Rather, this condition is defined as a set of symptoms that can arise from a variety of physical illnesses. These symptoms most often occur after discontinuation of drugs, psychoactive substances or in the case of poisoning with them.

The medical term delirium was first used in the first century AD. At that time, it denoted the mental disorders that the patient experienced during a high fever or after a head injury.

If you want to learn more about cognitive processes, read: Cognitive processes – division and characteristics, cognitive processes in a child, cognitive impairment in a child

There are known risk factors for delirium. It is noted that delirium most often develops in the elderly. In addition, people who struggle with cognitive dysfunction and dementia are at a higher risk.

What drug can be helpful in the case of cognitive disorders? Check: Citotrop for the nervous system – composition, indications and dosage

It is worth mentioning that the symptoms of delirium develop very quickly, i.e. from several hours to several days. The severity of these symptoms may vary throughout the day. Moreover, the symptoms of delirium very often worsen at night. Hallucinations can form film-like visions accompanied by delusions – the patient has a sense of participation in the events unfolding before his eyes. After the delirium has resolved, there is usually partial or complete amnesia of the delirium.

Delirium may appear, for example, in severe infections with high fever, poisoning, uremia, liver failure, injuries or dehydration (especially in the elderly). Delirium syndromes can also be a side effect of medication or withdrawal from alcohol or benzodiazepines.

It is estimated that delirium may be present in up to 20 percent. hospitalized patients. It is developing rapidly and carries with it both increased risk to patients’ lives and increased costs of medical care. According to estimates, approximately one in three cases of delirium in people in hospital could be prevented, but such interventions require considerable effort and resources – they cannot be used in everyone.

Delirium – high risk groups

Delirium as a symptom complex usually concerns specific cases. In risk group of people at risk of delirium are located:

1. people over 65 years of age;
2. people with cognitive impairment or dementia;
3. people struggling with a severe physical disease;
4. people after hip fracture.

Research and experience have shown that, on average, 60% of elderly people who are hospitalized for various reasons are at risk of delirium.

What should you know about dementia? Check: Dementia Diseases – Types and diagnosis of dementia

Diagnostics in the event of delirium

Diagnostic criteria for delirium have been formulated in the ICD-10 and DSM-IV disease classifications. These criteria include four basic elements:

1. consciousness disturbance;
2. cognitive dysfunction;
3. acute onset and variable severity of symptoms;
4. the presence of a somatic disease, poisoning or many possible etiologies. 

The ICD-10 classification also includes psychomotor disorders, changes in the rhythm of sleep and wakefulness, and emotional disorders. On the other hand, the experience of specialists has shown that the diagnosis of consciousness disorders should be taken into account in the case of even a slight change in the patient’s mental state.

Read more about emotional disorders: Emotional Disorders

Delirium – types

Delirium or delirium has been divided into 3 main characters:

1. hyperactive delirium – is distinguished by increased motor activity accompanied by mood swings, aggressive behavior and agitation. Patients speak much louder, in an incomprehensible and disorganized way. They are harder to control;
2. hypoactive delirium – it is distinguished by a reduction in psychomotor activity up to the state of reduced reactivity to stimuli. Patients in this case may appear sleepy or sick;
3. mixed delirium – it is distinguished by symptoms of disturbances of consciousness and attention, which are not accompanied by changes in motor activity. 

Delirium – consequences and prognosis

Delirium can have serious consequences for patients. People who have experienced delirium symptoms are at risk of:

1. longer hospitalization and complications associated with long-term treatment in the hospital;
2. dementia syndromes;
3. death – people with delirium die twice as often as people who have not experienced delirium. 

What is psychosis? Check: Psychosis – types and symptoms of the disease

How Can I Cope With Pain? Check: Pain Treatment

Delirium – a test for easier determination of the risk of disease

Developed by scientists at the University of California in San Francisco, the test allows a nurse to predict within two minutes whether a patient is at risk of severe mental disorders, reports the Journal of Hospital Medicine. The test developed by the team of Professor Vanji C. Douglas allows you to select people who are at the highest risk. The test is simple, effective and accurate. It allows you to better predict which patients are at risk and helps prevent disorders.

374 patients participated in the studies at UCSF and the San Francisco Veterans Affairs Medical Center – all were over 50 years old and showed no symptoms of delirium on admission to the hospital. Most of the patients were white and lived at home. On admission to the hospital, the patient was interviewed, asking questions about, inter alia, cognitive functions, place of residence, perceived pain, visual and hearing performance. The nurse assessed the patient’s condition on a scale ranging from “healthy” to “dying”.

Cognitive changes were assessed in all patients over six days – or up to the day of discharge. To determine the risk of delirium, scientists used a tool called the mnemonic abbreviation “AWOL”, A means age, W – inability to spell the word “world” backwards, O – lack of orientation as to the place, and L – the severity of the disease. Patients with a higher AWOL score were more likely to be confused and delirious, while those with a low AWOL were at a low risk of delirium. People at particular risk could be transferred to a ward specializing in the prevention of this type of pathology.

Delirium tremens, or alcohol delirium

A separate group of symptoms is delirium tremens, i.e. alcoholic delirium, white fever or trembling delirium. Delirium tremens is a state of altered mental status that is caused by abrupt withdrawal or a significant reduction in the dose of alcohol consumed. Alcoholic delirium is characterized by delusions and hallucinations that typically occur forty-eight to seventy-two hours after stopping alcohol consumption. The symptoms characteristic of delirium tremens usually intensify at night.

Delirium tremens has been designated by the International Statistical Classification of Diseases and Health Problems with the code F10.4.

Symptoms of delirium tremens:

1. contact problems with the surrounding world – the patient is unable to concentrate, does not build logical statements, does not give correct answers to the simplest questions and there is a slowdown in thinking;
2. as in the case of classical delirium, the patient is not oriented in time and space. A patient in a state of delirium tremens does not recognize his place, he is not able to determine the current date or time. He also often has a problem with his own identity and determining who he is, what his name is, where he lives, etc.
3. visual hallucinations such as hallucinations and delusions also occur. Usually hallucinations are very unpleasant for the patient as he can see demons or monsters. It often happens that he sees people who want to hurt him. Additionally, hallucinations are accompanied by auditory hallucinations and the patient hears sounds and voices that do not exist;
4. anxiety, fear and anxiety, which may additionally increase the patient’s aggression towards other people;
5. delirium during sleep;
6. mood swings that change very dynamically. For a moment the patient may be in a very good mood, only to be depressed for a moment. Similarly, he may be hyperactive for a moment, and apathetic and sleepy for a moment;
7. nausea and vomiting;
8. increase in body temperature;
9. accelerated heartbeat;
10. increased sweating;
11. the occurrence of convulsions and muscle cramps. 

Delirium tremens is a condition that threatens the health and life of the patient. Treatment of this condition should always be in a hospital setting. In the first stage, the patient’s condition and the functionality of the circulatory, respiratory and digestive systems should be assessed. Laboratory tests of blood should also be performed to assess blood glucose levels and hydration. During the treatment of delirium tremens, drugs from the benzodiazepine group are used, which are administered orally or intramuscularly.

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