Definition

What is delirium?

Delirium is a sudden, fluctuating, and usually reversible disturbance of mental function. It is characterized by an inability to pay attention, disorientation, an inability to think clearly, and fluctuations in the level of alertness (consciousness).

How common is delirium?

Please discuss with your doctor for further information.

Symptoms

What are the symptoms of delirium?

The common symptoms of delirium are:

  • Reduced awareness of the environment. This may result in:
    • An inability to stay focused on a topic or to switch topics
    • Getting stuck on an idea rather than responding to questions or conversation
    • Being easily distracted by unimportant things
    • Being withdrawn, with little or no activity or little response to the environment
  • Poor thinking skills (cognitive impairment). This may appear as:
    • Poor memory, particularly of recent events
    • Disorientation, for example, not knowing where you are or who you are
    • Difficulty speaking or recalling words
    • Rambling or nonsense speech
    • Trouble understanding speech
    • Difficulty reading or writing
  • Behavior changes. This may include:
    • Seeing things that don’t exist (hallucinations)
    • Restlessness, agitation or combative behavior
    • Calling out, moaning or making other sounds
    • Being quiet and withdrawn — especially in older adults
    • Slowed movement or lethargy
    • Disturbed sleep habits
    • Reversal of night-day sleep-wake cycle
  • Emotional disturbances. This may appear as:
    • Anxiety, fear or paranoia
    • Depression
    • Irritability or anger
    • A sense of feeling elated (euphoria)
    • Apathy
    • Rapid and unpredictable mood shifts
    • Personality changes

There may be some symptoms not listed above. If you have any concerns about a symptom, please consult your doctor.

When should I see my doctor?

If you have any signs or symptoms listed above or have any questions, please consult with your doctor. Everyone’s body acts differently. It is always best to discuss with your doctor what is best for your situation.

 

Causes

What causes delirium?

Delirium occurs when the normal sending and receiving of signals in the brain become impaired. This impairment is most likely caused by a combination of factors that make the brain vulnerable and trigger a malfunction in brain activity.

Delirium may have a single cause or more than one cause, such as a medical condition and medication toxicity. Sometimes no cause can be identified. Possible causes include:

  • Certain medications or drug toxicity
  • Alcohol or drug abuse or withdrawal
  • A medical condition
  • Metabolic imbalances, such as low sodium or low calcium
  • Severe, chronic or terminal illness
  • Fever and acute infection, particularly in children
  • Exposure to a toxin
  • Malnutrition or dehydration
  • Sleep deprivation or severe emotional distress
  • Pain
  • Surgery or other medical procedures that include anesthesia

Several medications or combinations of drugs can trigger delirium, including some types of:

  • Pain drugs
  • Sleep medications
  • Medications for mood disorders, such as anxiety and depression
  • Allergy medications (antihistamines)
  • Parkinson’s disease drugs
  • Drugs for treating spasms or convulsions
  • Asthma medications

Risk factors

What increases my risk for delirium?

There are many risk factors for delirium, such as:

  • Brain disorders such as dementia, stroke or Parkinson’s disease
  • Older age
  • Previous delirium episodes
  • Visual or hearing impairment
  • Having multiple medical problems

Diagnosis & treatment

The information provided is not a substitute for any medical advice. ALWAYS consult with your doctor for more information.

How is delirium diagnosed?

A doctor will diagnose delirium based on medical history, tests to assess mental status and the identification of possible contributing factors. An examination may include:

  • Mental status assessment. A doctor starts by assessing awareness, attention and thinking. This may be done informally through conversation, or with tests or screenings that assess mental state, confusion, perception and memory.
  • Physical and neurological exams. The doctor performs a physical exam, checking for signs of health problems or underlying disease. A neurological exam — checking vision, balance, coordination and reflexes — can help determine if a stroke or another neurological disease is causing the delirium.
  • Other possible tests. The doctor may order blood, urine and other diagnostic tests. Brain-imaging tests may be used when a diagnosis can’t be made with other available information.

How is delirium treated?

The first goal of treatment for delirium is to address any underlying causes or triggers — for example, by stopping use of a particular medication or treating an infection. Treatment then focuses on creating the best environment for healing the body and calming the brain.

Supportive care

Supportive care aims to prevent complications by:

  • Protecting the airway
  • Providing fluids and nutrition
  • Assisting with movement
  • Treating pain
  • Addressing incontinence
  • Avoiding use of physical restraints and bladder tubes
  • Avoiding changes in surroundings and caregivers when possible
  • Encouraging the involvement of family members or familiar people

Medications

Talk with the doctor about avoiding or minimizing the use of drugs that may trigger delirium. Certain medications may be needed to control pain that’s causing delirium.

Other types of drugs may help calm a person who misinterprets the environment in a way that leads to severe paranoia, fear or hallucinations, and when severe agitation or confusion occurs. These drugs may be needed when certain behaviors:

  • Prevent the performance of a medical exam or treatment
  • Endanger the person or threaten the safety of others
  • Don’t lessen with nondrug treatments

These medications are usually reduced in dose or discontinued when the delirium resolves.

Lifestyle changes & home remedies

What are some lifestyle changes or home remedies that can help me manage delirium?

The following lifestyles and home remedies might help you cope with delirium:

  • Promote good sleep habits.To promote good sleep habits:
    • Provide a calm, quiet environment
    • Keep inside lighting appropriate for the time of day
    • Plan for uninterrupted periods of sleep at night
    • Help the person keep a regular daytime schedule
    • Encourage self-care and activity during the day
  • Promote calmness and orientation. To help the person remain calm and well-oriented:
    • Provide a clock and calendar and refer to them regularly throughout the day
    • Communicate simply about any change in activity, such as time for lunch or time for bed
    • Keep familiar and favorite objects and pictures around, but avoid a cluttered environment
    • Approach the person calmly
    • Identify yourself or other people regularly
    • Avoid arguments
    • Use comfort measures, such as reassuring touch, when appropriate
    • Keep noise levels and other distractions to a minimum
    • Provide and maintain eyeglasses and hearing aids
    • Prevent complicating problems. Help prevent medical problems by:
    • Giving the person the proper medication on a regular schedule
    • Providing plenty of fluids and a healthy diet
    • Encouraging regular physical activity
    • Getting treatment for potential problems, such as infection or metabolic imbalances, early
  • Caring for the caregiver

Providing regular care for a person with delirium can be scary and exhausting. Take care of yourself, too.

  • Consider joining a support group for caregivers.
  • Learn more about the condition.
  • Ask for educational materials or other resources from a health care provider, nonprofit organizations, community health services or government agencies.
  • Share caregiving with family and friends who are familiar the person so you get a break.

If you have any questions, please consult with your doctor to better understand the best solution for you.

Hello Health Group does not provide medical advice, diagnosis or treatment.

 

Review Date: July 12, 2017 | Last Modified: July 12, 2017

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