Understanding delirium

Understanding Delirium: Causes, Types, and Treatment

Understanding delirium is important as it is something that can affect someone in an instant.

Delirium is a condition characterised by sudden changes in the brain, leading to emotional disruption and mental confusion.

It can make it difficult to focus, think, and remember things. In this blog post, we will explore the different types of delirium, its causes, and available treatment options.

Types of delirium

Delirium is a disturbance in mental function characterised by confusion, disorientation, and disturbances in attention, thinking, and perception. It can be classified into three main types:

  • delirium tremens
  • hyperactive delirium
  • hypoactive delirium

Each type has its own unique characteristics and symptoms.

Delirium tremens

Delirium tremens, also known as DTs, is a severe and potentially life-threatening form of delirium that occurs as a symptom of alcohol withdrawal. It typically occurs in individuals who have consumed excessive amounts of alcohol over a long period of time and suddenly stop drinking.

Symptoms of delirium tremens usually develop within 48 to 72 hours after the last drink and may include;

  • severe agitation
  • tremors
  • hallucinations
  • confusion
  • disorientation
  • rapid heartbeat
  • fever
  • sweating

Delirium tremens requires immediate medical attention and treatment to prevent complications and ensure the safety of the individual.

Hyperactive delirium

Hyperactive delirium is a type of delirium in which the person is highly agitated, restless, and suspicious. They may exhibit hyperactive behavior such as;

  • pacing
  • wandering
  • attempting to remove medical devices or equipment

Hyperactive delirium can be challenging to manage as the individual may be at risk of self-harm or harm to others.

Treatment for hyperactive delirium involves;

  • identifying and addressing the underlying cause
  • providing a calm and supportive environment
  • administering medications if necessary to manage symptoms and promote comfort

Hypoactive delirium

Hypoactive delirium, also known as hypoactive delirium syndrome, is a prevalent but often overlooked condition that affects a significant portion of hospitalised patients.

As previously mentioned, delirium is a state of acute confusion and altered consciousness that can have severe consequences if not promptly recognised and treated. While hyperactive delirium, characterised by agitation and restlessness, may be more obvious and easily diagnosed, hypoactive delirium presents with a more subtle and insidious set of symptoms. This can lead to delays in detection and appropriate management, resulting in adverse outcomes for patients.

Characteristics of hypoactive delirium are:

  • motor retardation
  • apathy
  • slowing of speech
  • patients can appear to be sedated

Causes of delirium

Delirium is a condition where a person experiences a sudden onset of confusion, disorientation, and changes in cognitive function. It is often caused by various conditions or medications that interfere with brain function. Understanding the underlying causes of delirium is crucial in order to properly treat and manage the condition.

Inflammation and infections

One of the most common causes of delirium is inflammation and infections, such as pneumonia. Infections in the body can trigger an immune response, resulting in the release of inflammatory mediators that can affect the brain. This neuro-inflammation can lead to delirium by disrupting normal brain functions.

Inflammatory conditions, like sepsis, can also lead to delirium. Sepsis is a severe infection that causes widespread inflammation and can have serious consequences on the brain. Patients with sepsis often develop delirium as a result of the inflammatory response.

Alcohol withdrawal

Alcohol withdrawal can also cause delirium. When individuals who are dependent on alcohol abruptly stop drinking, they may experience symptoms of withdrawal, including delirium. This condition, known as delirium tremens, typically occurs within 48 to 96 hours after the last drink and can be life-threatening if not properly managed.

The exact mechanisms through which alcohol withdrawal leads to delirium are not fully understood. It is believed that the sudden absence of alcohol alters neurotransmitter levels in the brain, leading to the manifestation of delirium symptoms.

Respiratory problems

Respiratory problems, such as asthma or chronic obstructive pulmonary disease (COPD), can also contribute to the development of delirium. Inadequate oxygen supply to the brain, caused by respiratory difficulties, can impair brain function and result in delirium.

Patients with underlying respiratory conditions should be closely monitored for signs of delirium, especially during episodes of exacerbation or acute respiratory distress. Prompt treatment of respiratory issues is essential in preventing delirium and its associated complications.

Medications

Certain medications have been identified as potential causes of delirium. These include sedatives, anticholinergic drugs, opioids, and antipsychotics. These medications can affect the neurotransmitter balance in the brain, leading to cognitive disturbances.

Sedatives, such as benzodiazepines, are commonly used to induce calmness and relaxation. However, in some individuals, these drugs can paradoxically cause delirium and confusion. It is important for healthcare providers to carefully assess the risks and benefits of administering sedatives, especially in older adults who may be more susceptible to delirium.

Anticholinergic drugs, including certain antihistamines and medications used to treat overactive bladder, can also contribute to delirium. These medications block the action of acetylcholine, a neurotransmitter involved in cognitive function. By interfering with acetylcholine, anticholinergic drugs can lead to delirium symptoms.

Symptoms of delirium

Delirium is a condition that can cause a wide range of symptoms, affecting various aspects of a person’s functioning.

It primarily affects;

  • the mind
  • muscle control
  • emotions
  • mood
  • sleep patterns

The symptoms of delirium can vary in severity and may come on suddenly or gradually.

One of the key symptoms of delirium is confusion.

Individuals with delirium often have trouble:

  • thinking clearly
  • focusing
  • maintaining attention

They may become easily distracted and have difficulty following conversations or instructions. This cognitive impairment can lead to disorientation and an inability to recognise familiar people or places.

Muscle control

Delirium can also impact muscle control, leading to problems with coordination, balance, and movement.

Individuals may exhibit the following:

  • tremors
  • restlessness
  • fidgeting

They may have trouble with tasks that require fine motor skills, such as writing or buttoning clothes.

Emotional and mood changes are common in delirium.

As such, individuals may experience heightened emotions, such as;

  • anxiety
  • irritability
  • agitation

They may also have rapid mood swings, going from elation to sadness or anger within a short period of time.

Sleep patterns can be significantly disrupted in delirium. Individuals may have difficulty falling asleep or staying asleep, leading to excessive daytime sleepiness. Alternatively, they may experience periods of excessive sleepiness or drowsiness.

In addition, delirium can affect the following:

  • concentration
  • attention
  • short-term memory

Individuals may have trouble completing tasks that require sustained focus or remembering recent events or conversations. This can contribute to the overall sense of confusion and disorientation.

Diagnosis of delirium

Diagnosing delirium involves a comprehensive evaluation of the individual’s symptoms and medical history. One commonly used method is the Confusion Assessment Method (CAM), which is designed to help doctors assess brain function and determine the presence of delirium.

The CAM involves a series of questions and observations to assess the individual’s attention, memory, thinking, and perception. It also evaluates the presence of certain features associated with delirium, such as;

  • fluctuating symptoms
  • incoherent speech
  • disorganised thinking

Blood tests

Along with the CAM, additional tests may be required to accurately diagnose delirium. Blood tests can help identify any underlying medical conditions or imbalances that may be contributing to the symptoms. Alcohol and drug tests may be necessary to rule out substance intoxication or withdrawal as a cause of delirium.

Imaging tests

Imaging tests, such as head scans, may be ordered to rule out other potential causes of the symptoms, such as a stroke or brain tumor. Other diagnostic procedures, such as electroencephalography (EEG) or lumbar puncture, may be done if there is suspicion of an underlying neurological condition or infection.

Overall, the diagnosis of delirium involves a comprehensive evaluation and consideration of various factors. It is important for individuals experiencing symptoms of delirium to seek medical attention for a proper diagnosis and appropriate treatment.

Treatment options

When it comes to treating delirium, it is important to understand that the approach will depend on the underlying cause. Since delirium can be caused by various factors, the treatment options may vary.

Such factors include;

  • medications
  • infections
  • electrolyte imbalances
  • other medical conditions

Here are some common treatment approaches that healthcare professionals may consider:

Medications

Medications can play a crucial role in managing delirium, especially when it is caused by specific factors such as drug reactions or imbalances in certain chemicals.

Antidepressants

Antidepressants, for example, may be prescribed if the delirium is related to depression. Thiamin

Thiamin

Thiamin supplements could be recommended if a deficiency is detected.

Sedatives

Sedatives or antipsychotic medications may also be used to calm down agitated individuals or manage hallucinations and delusions. Additionally, dopamine blockers may be prescribed for certain cases, as dopamine abnormalities can contribute to delirium.

Counselling and therapy

In some cases, delirium may be associated with mental health problems, such as anxiety or severe stress. In such situations, healthcare providers may recommend counselling or therapy sessions to address the underlying psychological issues.

By addressing these mental health concerns, it may be possible to alleviate delirium symptoms and prevent future episodes.

Preventing or managing underlying medical conditions

If the underlying cause of delirium is a medical condition, it is crucial to manage or treat the condition appropriately. This could involve administering antibiotics for infections, correcting electrolyte imbalances, or adjusting medications that may be contributing to delirium.

By effectively managing the underlying condition, the chances of delirium recurrence or worsening can be minimised.

Supportive Care

During the treatment process, providing supportive care is essential to ensure the comfort and well-being of individuals with delirium. This may include implementing a calming environment, ensuring proper nutrition and hydration, and addressing any additional needs, such as pain relief or mobility support. Supportive care aims to create a conducive setting for the individual’s recovery and overall well-being.

Conclusion

Delirium is a temporary condition that can be distressing for individuals experiencing it. It is important to understand the different types, causes, and treatment options in order to effectively manage and alleviate its symptoms.

If you or someone you know is experiencing delirium, seeking medical attention for proper diagnosis and treatment is paramount.

Types of delirium

Delirium can be classified into three main types:

  • delirium tremens
  • hyperactive
  • hypoactive
Delirium tremens

Delirium tremens is severe and may have life threatening consequences as it is brought on by alcohol withdrawal.

Hyperactive delirium

Hyperactive delirium is characterised by increased agitation, restlessness, and hallucinations.

Hypoactive delirium

Hypoactive delirium, on the other hand, is characterised by decreased activity, lethargy, and withdrawal.

Mixed delirium

Mixed delirium exhibits both hyperactive and hypoactive symptoms.

Understanding the type of delirium can guide healthcare professionals in determining the appropriate treatment approach.

Causes of delirium

Delirium can be caused by various factors, including medical conditions, medications, substance abuse, and environmental changes. Common medical conditions that can trigger delirium include infections, metabolic imbalances, and organ failure. Certain medications, especially those with sedative properties, can disrupt brain functioning and lead to delirium.

Substance abuse, particularly alcohol and illicit drugs, can also contribute to the development of delirium. Lastly, environmental changes such as hospitalisation or changes in routine can disrupt sleep patterns and trigger delirium.

Treatment Options

The treatment of delirium focuses on addressing the underlying cause, managing symptoms, and providing supportive care. Identifying and treating the root cause of delirium is crucial in preventing its progression and potential complications. This may involve treating infections, adjusting medications, or addressing any substance abuse issues. Additionally, managing symptoms such as agitation, restlessness, and confusion can help improve the individual’s comfort and overall well-being.

Supportive care is an integral part of the treatment plan for delirium. This includes creating a calm and familiar environment, promoting sleep and rest, and providing reassurance and emotional support. In some cases, healthcare professionals may recommend the use of certain medications to manage severe symptoms or to promote sleep. However, these medications should be used with caution and under close medical supervision.

It is important for individuals experiencing delirium, as well as their family members and caregivers, to understand the importance of seeking medical attention. Delirium can be a sign of an underlying medical condition that requires prompt diagnosis and treatment. By seeking medical help, individuals can receive appropriate care and support, leading to a faster recovery and improved outcomes.

Final conclusion

In conclusion, delirium is a temporary condition that can be distressing for those experiencing it. It is crucial to understand the different types, causes, and treatment options in order to effectively manage and alleviate its symptoms. Seeking medical attention is essential for proper diagnosis and treatment.

By providing the necessary support and care, individuals with delirium can recover faster and improve their overall well-being.

References:

Visit the NHS website via this link to learn more about delirium with helpful advice provided.

Learn more about other mental health conditions on our website by visiting this link.