Understand Delirium, Causes, Symptoms, Causes & Treatment

Delirium refers to a state of severe confusion and rapid changes in brain function that occur suddenly. It is related to hallucinations and hyperactivity, and the victim is inaccessible to normal contact.

  • Delirium can occur because of a wide variety of causes, including head trauma, drug use or withdrawal, poisoning, brain tumors, infections, and metabolic disorders.
  • A urinary tract infection or pneumonia, can lead to delirium in older people. The prognosis depends on the underlying cause of the disease.

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Symptoms of Delirium

Recognizing the symptoms of delirium is crucial for timely diagnosis and treatment. Here are the key symptoms to watch for:

  • Confusion: A noticeable change in cognitive function, resulting in difficulty thinking clearly and making decisions.
  • Disorientation: Trouble recognizing where you are, what time it is, or even who you are.
  • Attention Deficit: Difficulty maintaining focus or shifting attention between tasks.
  • Memory Problems: Short-term memory issues, such as trouble recalling recent events or conversations.
  • Hallucinations: Experiencing sights or sounds that are not present.
  • Language Difficulties: Problems with speaking or understanding speech, often leading to incoherent or slurred speech.
  • Restlessness and Agitation: Physical restlessness, which can include pacing or agitation and sometimes even aggressive behavior.
  • Sleep Disturbances: Changes in sleep patterns, including severe insomnia or daytime drowsiness.
  • Mood Swings: Rapid and unpredictable changes in mood, ranging from apathy to depression to euphoria.

Types Of Delirium

Delirium can be categorized into different types based on its causes and characteristics. The primary types of delirium are:

Hyperactive Delirium

This type of delirium is characterized by heightened arousal and increased motor activity. Symptoms include:

Hypoactive Delirium

Hypoactive delirium is often more subtle and can be mistaken for depression. Symptoms include:

  • Reduced motor activity
  • Drowsiness and lethargy
  • Withdrawal and apathy
  • Slow or sluggish responses

Mixed Delirium

Mixed delirium includes symptoms of both hyperactive and hypoactive delirium. Individuals may fluctuate between states of hyperactivity and hypoactivity. Symptoms include:

  • Alternating between periods of agitation and lethargy
  • Unpredictable behavior changes
  • Varied levels of awareness and responsiveness

Causes of Delirium

Delirium occurs when the brain's normal signaling processes are disrupted, likely due to a combination of factors that make the brain vulnerable and trigger dysfunction. It can have one or multiple causes, including medical conditions and drug toxicity. Sometimes, no cause can be identified. Possible causes include:

  • Medications: Certain medications or drug toxicity
  • Substance Use: Alcohol or drug intoxication or withdrawal
  • Medical Conditions: Stroke, heart attack, worsening lung or liver disease, injury from a fall
  • Metabolic Imbalances: Low sodium or calcium levels
  • Serious Illnesses: Chronic or terminal illnesses
  • Infections: Fever and acute infections, especially in children; urinary tract infections, pneumonia, or flu in the elderly
  • Exposure to Toxins: Carbon monoxide, cyanide, or other poisons
  • Nutritional Issues: Malnutrition or dehydration
  • Sleep and Emotional Issues: Sleep disorders or severe emotional distress
  • Pain and Surgery: Pain or surgery involving anesthesia

Medications That Can Trigger Delirium

Several drugs or drug combinations can trigger delirium, including:

  • Pain medications
  • Sleep medications
  • Mood disorder medications (for anxiety and depression)
  • Allergy medications (antihistamines)
  • Asthma medications
  • Steroid drugs (corticosteroids)
  • Parkinson's disease medications
  • Medications for spasms or convulsions

Treatment of Delirium

  • If a person unexpectedly develops confusion, urgent medical attention should be sought. Often, the patient is too confused to inform doctors of their condition, and the history is often taken from a family member or someone who knows the patient well.
  • Treatment aims to correct the underlying cause. For example, the infection would be treated with antibiotics.
  • Sedatives can make delirium worse and should only be given where:
    • Patients are extremely anxious
    • The patient has suddenly withdrawn from alcohol or drugs
    • When the patient risks endangering himself or others
    • To calm someone down enough to receive treatment

When to visit a Doctor?

See a doctor immediately if you or someone else suddenly:

  • Sees or hears things that others do not see
  • Gets confused and doesn't know where they are
  • They no longer recognize the people around them

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Prevention of Delirium

Treating the conditions that cause delirium can lower its risk. In hospitalized people, avoiding or using a lower dosage of sedatives, prompt treatment of metabolic conditions and infections, and using reality counselling programs will reduce the risk in those at high risk.


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Frequently Asked Questions

1. Can you recover from delirium?

Delirium usually improves when the underlying cause is treated. Recovery can be quick, but it can sometimes take days or even weeks, and some lingering effects may persist.

2. How long can you live with delirium?

Delirium can last for a few days, weeks, or even months, but people with dementia may take longer to recover. In hospitals, about 20-30% of older people in medical services will suffer from delirium, and up to 50% of people will have dementia.

3. What triggers delirium?

Delirium can be triggered by a serious medical illness such as infection, certain medications, and other causes, such as drug withdrawal or intoxication. Older patients over 65 are most at risk of developing delirium. People with a history of brain disease or brain damage are also at risk.

4. What is delirium?

Delirium is an acute, often fluctuating change in mental status characterized by confusion, altered consciousness, and impaired cognitive function.

5. What are the symptoms of delirium?

Symptoms of delirium include confusion, disorientation, difficulty concentrating, memory problems, hallucinations, and changes in alertness or awareness.

6. What causes delirium?

Various factors, including infections, medication side effects, substance withdrawal, severe illnesses, metabolic imbalances, and brain injuries, can cause delirium.

7. How is delirium diagnosed?

Delirium is diagnosed through clinical assessment, patient history, physical examination, and sometimes additional tests to identify underlying causes.

8. What are the treatment options for delirium?

Treatment for delirium involves addressing the underlying cause, providing supportive care, managing symptoms, and ensuring a safe environment for the patient.

9. How do you detect delirium?

Detecting delirium involves a clinical assessment, patient history, cognitive tests like CAM and MMSE, physical exams, lab tests, imaging studies, and a review of medications. Seek prompt medical attention if delirium is suspected.

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