delirium

Delirium

Definition

Delirium is a state of mental confusion that develops quickly and usually fluctuates in intensity.

Description

Delirium is a syndrome, or group of symptoms, caused by a disturbance in the normal functioning of the brain. The delirious patient has a reduced awareness of and responsiveness to the environment, which may be manifested as disorientation, incoherence, and memory disturbance. Delirium is often marked by hallucinations, delusions, and a dream-like state.Delirium affects at least one in 10 hospitalized patients, and is a common part of many terminal illnesses. Delirium is more common in the elderly than in the general population. While it is not a specific disease itself, patients with delirium usually fare worse than those with the same illness who do not have delirium.

Causes and symptoms

Causes

There are a large number of possible causes of delirium. Metabolic disorders are the single most common cause, accounting for 20-40% of all cases. This type of delirium, termed "metabolic encephalopathy," may result from organ failure, including liver or kidney failure. Other metabolic causes include diabetes mellitus, hyperthyroidism and hypothyroidism, vitamin deficiencies, and imbalances of fluids and electrolytes in the blood. Severe dehydration can also cause delirium.Drug intoxication ("intoxication confusional state") is responsible for up to 20% of delirium cases, either from side effects, overdose, or deliberate ingestion of a mind-altering substance. Medicinal drugs with delirium as a possible side effect or result of overdose include:

anticholinergics, including atropine, scopolamine, chlorpromazine (an antipsychotic), and diphenhydramine (an antihistamine)
sedatives, including barbiturates, benzodiazepines, and ethanol (drinking alcohol)
antidepressant drugs
anticonvulsant drugs
nonsteroidal anti-inflammatory drugs (NSAIDs), including ibuprofen and acetaminophen
corticosteroids, including prednisone
anticancer drugs, including methotrexate and procarbazine
lithium
cimetidine
antibiotics
L-dopa

Delirium may result from ingestion of legal or illegal psychoactive drugs, including:

ethanol (drinking alcohol)
marijuana
LSD (lysergic acid diethylamide) and other hallucinogens
amphetamines
cocaine
opiates, including heroin and morphine
PCP (phencyclidine)
inhalants

Drug withdrawal may also cause delirium. Delirium tremens, or "DTs," may occur during alcohol withdrawal after prolonged or intense consumption. Withdrawal symptoms are also possible from many of the psychoactive prescription drugs.Poisons may cause delirium ("toxic encephalopathy"), including:

solvents, such as gasoline, kerosene, turpentine, benzene, and alcohols
carbon monoxide
refrigerants (Freon)
heavy metals, such as lead, mercury, and arsenic
insecticides, such as Parathion and Sevin
mushrooms, such as Amanita species
plants such as jimsonweed (Datura stramonium) and morning glory (Ipomoea spp.)
animal venoms

Other causes of delirium include:

infection
fever
head trauma
epilepsy
brain hemorrhage or infarction
brain tumor
low blood oxygen (hypoxemia)
high blood carbon dioxide (hypercapnia)
post-surgical complication

Symptoms

The symptoms of delirium come on quickly, in hours or days, in contrast to those of dementia, which develop much more slowly. Delirium symptoms typically fluctuate through the day, with periods of relative calm and lucidity alternating with periods of florid delirium. The hallmark of delirium is a fluctuating level of consciousness. Symptoms may include:

decreased awareness of the environment
confusion or disorientation, especially of time
memory impairment, especially of recent events

hallucinations
illusions and misinterpreted stimuli
increased or decreased activity level
mood disturbance, possibly including anxiety, euphoria or depression
language or speech impairment

Diagnosis

Delirium is diagnosed through the medical history and recognition of symptoms during mental status examination. The most important part of diagnosis is determining the cause of the delirium. Tests may include blood and urine analysis for levels of drugs, fluids, electrolytes, and blood gases, and to test for infection; lumbar puncture ("spinal tap") to test for central nervous system infection; x ray, computed tomography scans (CT), or magnetic resonance imaging (MRI) scans to look for tumors, hemorrhage, or other brain abnormality; thyroid tests; electroencephalography (EEG); electrocardiography (ECG); and possibly others as dictated by the likely cause.

Treatment

Treatment of delirium begins with recognizing and treating the underlying cause. Delirium itself is managed by reducing disturbing stimuli, or providing soothing ones; use of simple, clear language in communication; and reassurance, especially from family members. Physical restraints may be needed if the patient is a danger to himself or others, or if he insists on removing necessary medical equipment such as intravenous lines or monitors. Sedatives or antipsychotic drugs may be used to reduce anxiety, hallucinations, and delusions.

Prognosis

Persons with delirium usually have a worse prognosis for the underlying disease than the person without delirium. Nonetheless, those without terminal illness usually recover from delirium. They may not, however, regain all their original cognitive abilities, and may be left with some permanent impairments, including fatigue, irritability, difficulty concentrating, or mood changes.

Prevention

Prevention of delirium is focused on treating or avoiding its underlying causes. The most preventable forms are those induced by drugs. Strategies for reducing delirium include following prescriptions, consulting the prescribing physician immediately if symptoms occur, and consulting the physician before discontinuing the drug, even if it has been ineffective; avoiding intoxication with legal or illegal drugs, and seeking professional assistance before suddenly discontinuing an addictive drug such as alcohol or heroin; maintaining good nutrition, which promotes general health and can minimize the likelihood of delirium from alcohol intoxication and withdrawal; and avoiding exposure to solvents, insecticides, heavy metals, or biological poisons in the home or workplace.

Resources

Books

Guze, Samuel, editor. Adult Psychiatry. Mosby Year Book, 1997.

Key terms

Dementia — A loss of mental ability severe enough to interfere with functioning. While dementia and delirium have some of the same symptoms, dementia has a much slower onset.Electroencephalogram (EEG) — A chart of the brain wave patterns picked up by electrodes placed on the scalp. This is useful for diagnosing central nervous system disorders.Encephalopathy — A brain dysfunction or disorder.

delirium

[dĕ-lēr´e-um] (pl. deli´ria) An acute, transient disturbance of consciousness accompanied by a change in cognition and having a fluctuating course. Characteristics include reduced ability to maintain attention to external stimuli and disorganized thinking as manifested by rambling, irrelevant, or incoherent speech; there may also be a reduced consciousness" >level of consciousness, sensory misperceptions, disturbance of the sleep-wakefulness cycle and level of psychomotor activity, disorientation to time, place, or person, and memory impairment. Delirium may be caused by a number of conditions that result in derangement of cerebral metabolism, including systemic infection, cerebral tumor, poisoning, drug intoxication or withdrawal, seizures or head trauma, and metabolic disturbances such as fluid, electrolyte, or acid-base imbalance, hypoxia, hypoglycemia, or hepatic or renal failure.alcohol withdrawal delirium (delirium tre´mens) an acute alcohol withdrawal" >withdrawal syndrome that can occur in any person who has a history of drinking heavily and suddenly stops. It can occur with any form of alcoholic beverage, including beer and wine, and is most commonly seen in chronic alcoholics. The severity of the symptoms usually depends on the length of time the patient has had a problem of alcohol abuse and the amount of alcohol that had been drunk before the abstinence that precipitated the delirium. See also alcoholism.Clinical Course. Generally, this syndrome begins a few days after drinking has ceased and ends within 1–5 days. It can be heralded by a variety of signs and symptoms. Some patients exhibit only mild tremulousness, irritability, difficulty in sleeping, an elevated pulse rate and hypertension, and increased temperature. Others have generalized convulsions as the first sign of difficulty. Most persons exhibit severe memory disturbance, agitation, anorexia, and hallucinations.
Hallucinations are likely to follow the early signs and usually, but not always, are unpleasant and threatening to the patient. These hallucinations can be of three types: auditory, visual, or tactile. Delusions often follow or accompany the hallucinations. These patients are unable to think clearly and sometimes become paranoid and greatly agitated. At this point they can become dangerous to themselves and others.
Generalized grand mal seizures can occur in delirium tremens. The hallucinations and delusions may continue, contributing to the state of agitation and precipitating seizures. Treatment and Patient Care. Persons with delirium tremens are very ill and have multiple short-term and long-term problems. They should be kept in a quiet, nonstimulating environment and approached in a calm, reassuring manner. They must be watched closely and protected from self-injury during the period of delirium and also when they are convalescing from their illness and are likely to feel great remorse and depression. They should be observed for signs of extreme fatigue, pneumonia, or heart failure. Respiratory infections are quite common in these patients because of their weakened condition and inattention to personal hygiene.
The diet should be high in fluid intake and carbohydrate content and low in fats. If the patient has cirrhosis, protein intake may be limited. Dietary supplements usually include vitamin preparations, especially the B complex vitamins. If the patient is unable to cooperate by taking fluids and food by mouth, tube feeding and intravenous fluids may be necessary. Tranquilizing agents and sedatives are useful for therapy.

de·lir·i·um

, pl.

de·lir·i·a

(dĕ-lir'ē-ŭm, dĕ-lir'ē-ă), An altered state of consciousness, consisting of confusion, distractibility, disorientation, disordered thinking and memory, defective perception (illusions and hallucinations), prominent hyperactivity, agitation, and autonomic nervous system overactivity; caused by illness, medication, or toxic, structural, and metabolic disorders. [L. fr. deliro, to be crazy, fr. de- + lira, a furrow (i.e., go out of the furrow)]

delirium

(dĭ-lîr′ē-əm)n. pl. delir·iums or delir·ia (-ē-ə) A temporary state of mental confusion and fluctuating consciousness resulting from high fever, intoxication, shock, or other causes. It is characterized by anxiety, disorientation, hallucinations, delusions, and incoherent speech.

de·lir′i·ant adj.

delirium

Neurology An acute organic brain disorder caused by a defect in cognate functions with global impairment and a ↓ clarity of awareness of the environment, which may progress or regress Etiology May be multifactorial–eg, due to toxins; substance abuse; acute psychosis, medication–eg anticholinergics; anemia, brain lesions–eg 1º tumors or metastases; chemotherapy–eg, MTX, corticosteroids, asparginase, vincristine; endocrinopathies–eg, hypoglycemia; fever; infection; metabolic derangement–eg, ↑ Ca2+, ↓ Na+ paraneoplastic syndromes Clinical Disturbance of sleep-wake cycle, with insomnia and/or daytime drowsiness, altered psychomotor activity, perceptual disturbances, and behavior changes–eg anger, anxiety, depression, fear, irritability, paranoia, withdrawal, most prominent at night Diagnosis EEG–slowing of brain waves; cognitive capacity screening examination; mini-mental state test; trail-making B test. See Black patch delirium, Fatal excited delirium, Pseudodelirium. Cf Dementia.

de·lir·i·um

, pl. deliria (dĕ-lir'ē-ŭm, -ă) An altered state of consciousness, consisting of confusion, distractibility, disorientation, disordered thinking and memory, defective perception (illusions and hallucinations), prominent hyperactivity, agitation, and autonomic nervous system overactivity; caused by a number of toxic structural and metabolic disorders. [L. fr. deliro, to be crazy]

delirium

A mental disturbance from disorder of brain function caused by high fever, head injury, drug intoxication, drug overdosage or drug withdrawal. There is confusion, disorientation, restlessness, trembling, fearfulness, DELUSION and disorder of sensation (HALLUCINATION). Occasionally there is maniacal excitement.

de·lir·i·um

, pl. deliria (dĕ-lir'ē-ŭm, dĕ-lirē-ŭm, -ă) An altered state of consciousness, consisting of confusion, distractibility, disorientation, disordered thinking and memory and other signs; caused by illness, medication, or toxic, structural, and metabolic disorders. [L. fr. deliro, to be crazy]

Delirium

Related to Delirium: delirium tremens

DELIRIUM, med.jur. A disease of the mind produced by inflammations, particularly in fevers, and other bodily diseases.
2. It is also occasioned by intoxicating agents.
3. Delirium manifests its first appearance "by a propensity of the patient to talk during sleep, and a momentary forgetfulness of his situation, and of things about him, on waking from it. And after being fully aroused, however, and his senses collected, the mind is comparatively clear and tranquil, till the next slumber, when the same scene is repeated. Gradually the mental disorder becomes more intense, and the intervals between its returns of shorter duration, until they are scarcely, or not at all perceptible. The patient lies on his back, his eyes, if open, presenting a dull and listless look, and is almost constantly talking to himself in a low, muttering tone. Regardless of persons or things around him and scarcely capable of recognizing them when aroused by his attendants, his mind retires within itself to dwell upon the scenes and events of the past, which pass before it in wild and disorderly array, while the tongue feebly records the varying impressions, in the form of disjointed, incoherent discourse, or of senseless rhapsody. In the delirium which occurs towards the end of chrome diseases, the discourse is often more coherent and continuous, though the mind is no less absorbed in its own reveries. As the disorder advances, the voice becomes more indistinct, the fingers are constantly picking at the bed-clothes, the evacuations are passed insensibly, and the patient is incapable of being aroused to any further effort of attention. In some cases, delirium is attended with a greater degree of nervous and vascular excitement, which more or less modifies the abovementioned symptoms. The eyes are open, dry, and bloodshot, intently gazing into vacancy, as if fixed on some object which is really present to the mind of the patient; the skin is hotter and dryer; and he is more restless and intractable. He talks more loudly, occasionally breaking out into cries and vociferation, and tosses about in bed, frequently endeavoring to get up, though without any particular object in view." Ray, Med. Jur. Sec. 213.
4. "So closely does delirium resemble mania to the casual observer, and so important is it that they should be distinguished from each other, that it may be well to indicate some of the most common and prominent features of each. In mania, the patient recognizes persons and things, and is perfectly conscious of, and remembers what is passing around him. In delirium, he can seldom distinguish one person or thing from another, and, as if fully occupied with the images that crowd upon his memory, gives no attention to those that are presented from without. In delirium, there is an entire abolition of the reasoning power; there is no attempt at reasoning at all; the ideas are all and equally insane; no single train of thought escapes the morbid influence, nor does a single operation of the mind reveal a glimpse of its natural vigor and acuteness. In mania, however false and absurd the ideas may be, we are never at a loss to discover patches of coherence, and some semblance of logical sequence in the discourse. The patient still reasons, but he reasons incorrectly. In mania, the muscular power is not perceptibly diminished, and the individual moves about with his ordinary ability. Delirium is invariably attended with great muscular debility; and the patient is confined to bed, and is capable of only a momentary effort of exertion. In mania, sensation is not necessarily impaired and, in most instances, the maniac sees, bears, and feels with all his natural acuteness. In delirium, sensation is greatly impaired, and this avenue to the understanding seems to be entirely closed. In mania, many of the bodily functions are undisturbed, and the appearance of the patient might not, at first sight, convey the impression of disease. In delirium, every function suffers, and the whole aspect of the patient is indicative of disease. Mania exists alone and independent of any other disorder, while delirium is only a symptom or attendant of some other disease. Being a symptom only, the latter maintains certain relations with the disease on which it depends; it is relieved when that is relieved, and is aggravated when that increases in severity. Mannia, though it undoubtedly tends to shorten life, is not immediately dangerous; whereas the disease on which delirium depends, speedily terminates in death, or restoration to health. Mania never occurs till after the age of puberty; delirium attacks all periods alike, from early childhood to extreme old age." Id. Sec. 216.
5. In the inquiry as to the validity of testamentary dispositions, it is of great importance, in many cases, to ascertain whether the testator labored under delirium, or whether he was of sound mind. Vide Sound mind; Unsound mind; 2 Addams, R. 441; 1 Addams, Rep. 229, 383; 1 Hagg. R. 577; 2 Hagg. R. 142; 1 Lee, Eccl. R. 130; 2 Lee, Eccl. R. 229; 1 Hag. Eccl. Rep. 256.

delirium

de·lir·i·um

delirium

de•lir•i•um

delirium

Delirium

delirium

Delirium

delirium

Delirium

Delirium

delirium

Delirium

delirium

Delirium

Definition

Description

Causes and symptoms

Causes

Symptoms

Diagnosis

Treatment

Prognosis

Prevention

Resources

Books

Key terms

delirium

de·lir·i·um

de·lir·i·a

delirium

delirium

de·lir·i·um

delirium

de·lir·i·um

Delirium

delirium

Synonyms for delirium

noun madness

Synonyms

noun frenzy

Synonyms

Synonyms for delirium

noun state of violent mental agitation

Synonyms

Related Words

noun a usually brief state of excitement and mental confusion often accompanied by hallucinations

Related Words