Delirium

Overview

Delirium is a health condition that affects the mental state. The person suffering from delirium can not remember things easily and clearly, has a confused state of mind, and is especially disoriented. Delirium is a temporary health complication, and it is often treatable.

There are three (3) types of delirium, which are hypoactive, mixed, and hyperactive delirium. Depending on the kind of delirium, the state of mind causes the patient to be in different moods.

Delirium originates in the Latin word “dēlīrium,” meaning madness or derangement.

Types of Delirium

There are three types of delirium, which are dependent on the mood of the patient.

• Hypoactive Delirium:

This is the calm state of mind as the patient is not active. Here the patient is going through depression or may feel sleepy or tired.

• Hyperactive Delirium:

As this is the most engaged state of mind, the patient is very active and could be dangerous to approach in this state. The patient becomes restless or agitated.

• Mixed Delirium:

The patient typically goes from hypoactive to hyperactive states interchangeably.

Key Facts

• Delirium is a mental condition in which the mind is not in a healthy state.
• Patients suffering from delirium can be disoriented, confused, and they may be unable to think clearly or remember things.
• Delirium can sometimes lead to hallucinations where patients imagine or see things unreal.
• It is a temporary health complication and can be treated
• It is most likely to occur in older people
• It is also most likely to occur in patients who had head surgery, have diseases such as Human Immunodeficiency Virus (HIV), and patients who are hospitalised in Intensive Care Units (ICUs)

Symptoms 

The different types of delirium produce various symptoms. These symptoms start gradually and tend to progress to the worst stages at a later time if not treated or managed. Depending on the type of delirium, the patient may experience the following symptoms:

• Hyperactive Delirium:

1. Hallucinations: As hallucination is a common thing for people on opioids or that has a disoriented mental state, it is among the symptoms of hyperactive delirium patients.
2. Anxiety: The patient progressively becomes anxious or nervous 
3. Difficulty or trouble concentrating:

One of the significant symptoms of delirium is the inability to pay attention. Patients struggle to pay attention or concentrate.

4. Restlessness

• Hypoactive Delirium:
  1. Apathy: Patients are disinterested in anything exciting.
  2. Laziness: Their body is always wanting to rest or sleep.
  3. Withdrawal: They withdraw from activities due to their numb state of mind.

• Mixed Delirium:
  • Changing consciousness level: They have switches or mood swings easily.
  • Disturbed patterns of sleep

Diagnosis 

The doctor can investigate troubles relating to concentration, attention, memory, orientation, and visual perception. This can be quickly done by putting patients through easy simple tasks that test for these troubles. Tests can be simple mathematical problems or the spelling of a simple short word backward.

If the doctor suspects delirium depending on how the patient performed in the simple tests, he can proceed to ask questions about the medical history of the patient, which can include symptoms the patient is experiencing. The doctor can confirm and diagnose a patient with delirium with positive results from neurological examinations, laboratory, and imaging tests.

Causes

The factors that cause delirium can launch a person directly into delirium if not cared for or adequately managed. These include:

• Alcohol or drug abuse: Alcohol abuse causes derangement and progressive memory loss. Drugs such as opioids harm the healthy state of mind. Hence, it is necessary for patients who have delirium already to abstain from opioids and alcohol. This factor can also occur as a result of withdrawal syndrome. Patients who are addicted to alcohol or opioids face delirium tremens, a syndrome as a result of withdrawal.
• Electrolyte imbalance/Dehydration: The brain is full of mitochondria, a cell that powers the brain. These cells work with electrolyte and ATP (adenosine triphosphate) that generates the energy the brain needs. When this is lacking, the brain risks shutting down as the patient passes out.
• Infections and Diseases: Infections such as the flu, HIV, and Urinary Tract Infections (UTIs) can cause hypoactive delirium; the patient especially gets a feeling of worthlessness and progressively becomes apathetic and withdraws from social activities.
• Surgeries: This can be a head surgery or a patient reacting to the anesthesia used during surgeries.
• Hospitalization: Keeping patients for a long time at ICUs can cause delirium as the environment affects their mental state.
• Medications: Medicines given to patients to control aggressiveness, such as sedatives, can hamper mental health. 

Prevention

Delirium can be prevented by avoiding the factor that causes it. These may include:

• Doctors can avoid the use of opioids in their medical line of treatment, especially when treating patients with suspected cases of delirium
• Intensive Care Units (ICUs) or Hospital environments can generally be managed to ensure it is quiet, tranquil, and adequately lit.
• For better improvement and fast recovery, family members can be around patients with delirium for connection.

Typical Treatment

Delirium can be treated if the cause is known. Therefore, depending on the cause, the doctor can employ any of these lines of treatment:

• Use of Antibiotics: Urinary Tract Infections (UTIs) are possible causes of delirium, and they can be treated easily by the use of antibiotics. Although some strains of microorganisms causing the UTI might be resistant to a particular antibiotic, the doctor is advised to conduct antibiotic testing on the patient’s UTI to know the antibiotic that can be best deployed.
• Use of Electrolyte: This is best employed if dehydration is the cause of the patient’s delirium. Electrolytes can be given orally, through injections, and drips.
• Benzodiazepines: This medication is used to control delirium tremens, a syndrome resulting from alcohol withdrawal. It is otherwise called withdrawal syndrome.
• Antipsychotic medications: In the worst or extreme cases of delirium, such as hyperactive delirium, the doctor can prescribe antipsychotic drugs. This includes Olanzapine, Quetiapine, Risperidone, and Haloperidol.

Conclusion

Delirium is a health condition that affects the mental state. It is temporary and can be treated if the cause is known. The factors that can cause it to vary from self-inflicted, such as addiction to alcohol or abuse of opioids, contraction of infection such as UTI or HIV, to medically inflicted, such as patient reacting to the anaesthesia used during surgery. Aside from this range, older people are pretty likely to have delirium. Patients should contact their doctors if the patient notices any symptoms of delirium so as to treat delirium early.

MOST COMMON