What does it mean to be delirious? What might cause someone to be confused and disoriented, and what can be done to treat it? In this lesson, we’ll look at the symptoms, causes, and treatment of delirium.
Charlotte is in the hospital because she fell and had to have hip replacement surgery. Her granddaughter Mimi comes to visit her often, and soon Mimi notices a strange pattern.
When she visits Charlotte in the morning, she seems OK. She talks and acts normally, though sometimes she gazes off into space and seems to get lost in her own thoughts. But overall, Charlotte seems fine in the mornings.But when Mimi comes to visit in the afternoons or evenings, something is different. Charlotte seems confused and sometimes doesn’t know what day it is or where she is. Her attention wanders, and she doesn’t always seem to be aware that Mimi is there.
The doctors who check in on Charlotte usually do their rounds in the morning, so they don’t ever see her at her worst. But Mimi is concerned. She heard in her psychology class at school that some people suffer from delirium, a cognitive disorder that involves confusion and disorientation, among other symptoms. Could Charlotte have delirium?
Imagine that you are a psychiatrist, and Mimi asks you to visit Charlotte in the evening, when she’s at her worst. When you arrive, you see some symptoms of delirium. In order to diagnose Charlotte, you go down a checklist of the criteria for delirium.
1. Less attention to the environment and less ability to focus attention. Charlotte’s attention drifts off, and she seems in her own world. She definitely fits this criterion.2. A change in thinking or perceiving that’s not explained by another condition.
Charlotte has a hard time coming up with the right words to express herself, and sometimes has a hard time understanding others. These are examples of cognitive difficulties that go along with delirium.Occasionally, patients will also see things, or hallucinate. Though Charlotte isn’t hallucinating, she has lost cognitive functioning, and there’s not another psychological condition, like dementia, that could explain it.3. The symptoms develop quickly and fluctuate during the day. Charlotte’s delirium came on over a few days, and she’s usually better in the morning than the evening, so you can check this one off.
4. There is evidence that it is caused by a medical condition. When you examine Charlotte, you notice that she has developed an infection after her hip surgery.
The delirium might be caused by that.Because Charlotte meets all four criteria, you can diagnose her with delirium.
Delirium or Dementia?
Delirium is sometimes confused with dementia, another cognitive disorder that involves losing the ability to think clearly and losing memories. Because delirium and dementia are so similar, someone with delirium can be diagnosed with dementia and vice versa. But there are a few key differences.1. Onset of the condition.
Delirium usually develops quickly, within a few days, while dementia develops slowly over months or years.2. Attention. Someone with delirium often has problems engaging or disengaging their attention.
As a result, they often come across as ‘out of it.’ In contrast, patients in the early stages of dementia are usually alert.3. Fluctuation. While dementia patients are usually the same no matter when you talk to them, delirium patients’ symptoms fluctuate during the day. Sundowning, or worsening of symptoms as night sets in, is common for delirium patients.
Causes & Treatment
What can cause delirium? There are many different ways that someone could get delirium. Age is a factor that can make a person vulnerable to it: the elderly and young children are more likely to develop delirium than a healthy person in their prime. For example, Charlotte is more susceptible to developing delirium than her college-aged granddaughter Mimi.Sometimes, substance abuse or withdrawal can cause delirium.
Drugs, like alcohol, marijuana, and stimulants, can cause delirium. Vitamin deficiencies, some prescription drug combinations, and heavy-metal poisoning are also causes.Finally, some medical conditions, like infections or brain lesions, can cause delirium. Remember that when you examined Charlotte, you found that she had developed a post-operative infection. This is most likely the cause of her delirium.Treatment usually involves several steps.
First, the doctor will focus on treating the underlying cause of the delirium. For example, a doctor might give a patient vitamins if he or she has a deficiency, or change a person’s medication if that is the cause. In Charlotte’s case, the focus will be on treating the infection that she developed.
In addition to treating the underlying cause, some treatments also address the environment of the patient. Remember that Charlotte sometimes seems unaware of what day or time it is, a common symptom of delirium. Placing large clocks and calendars where patients can see them can help with that.Other common environment-based treatments include surrounding the patient with mementos and photos, having the patient work with a therapist to relearn how to take care of oneself, and having friends and family around.
Delirium is a cognitive disorder marked by confusion and disorientation. It is often confused with dementia but has a more sudden onset, involves problems with attention, and the symptoms fluctuate during the day.
There are many causes of delirium, including drug and alcohol abuse, vitamin deficiencies, infections, and brain damage. Treatment involves addressing the underlying cause of the delirium and making the environment as comfortable for patients as possible.
After watching this lesson, you should be able to examine the causes, symptoms, and treatment options for individuals with delirium.