Delirium is a state of mental confusion. People who suffer from it lose their cognitive and mental abilities, among other things, and need immediate treatment. Delirium can also be prevented.
What is delirium?
Delirium, often also referred to as delirium, is understood in medicine as a state of mental confusion. Affected persons suffer from disturbances of consciousness and thinking ability and are often also physically impaired. The causes of the disease are diverse and range from alcohol and drug abuse to cardiovascular diseases, fractures and malnutrition. Equally varied are the possible symptoms that can accompany delirium. Treatment focuses on addressing the underlying cause, with only medications also addressing the specific symptoms of delirium.
Causes
The causes of delirium depend on several factors. Normally, the symptom results from central nervous disorders, among other causes. These include bleeding, vascular disease, and tumors, as well as epilepsy, meningitis, encephalitis, or migraine. Sleep deprivation can also trigger a form of delirium. So can systemic diseases, i.e. infections as well as fever, deprivation or electrolyte disturbances. Metabolic disorders such as hyperglycemia, renal failure or anemia are also known causes of delirium. The same is true for acidosis, alkalosis, vitamin deficiency, and various types of obstructive sleep apnea. Medications and delirantia, as well as drugs and their withdrawal, are also possible triggers of delirium. So are malnutrition, fractures, head injuries, and hypoxia. The most common cause is alcohol withdrawal from alcoholism. This so-called delirium tremens is also known as alcohol withdrawal delirium. In addition, delirium can also be caused by diseases of the heart, such as cardiac arrhythmias and heart failure, as well as shock. Even pulmonary embolism or myocardial infarction can result in delirium. Because of the variety of possible causes, it is even more important to seek medical attention at the first signs.
Symptoms, complaints, and signs
Delirium is accompanied by a wide variety of complaints. Affected persons suffer primarily from a disturbance of consciousness and attention. As a result, there are perceptual disturbances, memory is impaired, and the ability to orient oneself decreases. In addition, psychomotor disorders can occur, ranging from excessive emotions and poor concentration to a complete change in personality structure. People who are delirious are no longer able to perform abstract thought processes and have a limited short-term memory. If delirium is full-blown, there are additional sleep disturbances, hallucinations and affective disorders such as depression, anxiety or irritability. This, in turn, causes agitation, i.e. a pathological restlessness, which further intensifies the above-mentioned symptoms. Rapid treatment of delirium is absolutely necessary for these reasons.
Diagnosis and course
The diagnosis can usually be made by a physician already on the basis of the symptoms. In addition, certain test procedures such as CAM are performed, which can be used to measure the severity of delirium. The actual cause is difficult to determine due to the large number of possible factors and diseases. For this reason, the diagnosis initially focuses on a careful recording of the patient’s medical history. Within the anamnesis, it is clarified whether and which previous illnesses are present, whether alcohol or drug abuse exists and what the general life situation of the patient looks like. This allows a comprehensive picture to be drawn up, which is just as helpful in the search for the cause as it is in the subsequent treatment. Treated early, the chance of complete recovery is relatively high. However, the course of delirium can be fatal, depending on the cause.
Complications
Because delirium combines a variety of symptoms, it usually also results in many different complications. In most cases, the patient suffers from severe disorientation and perceptual disturbances. This can greatly affect daily life and living and reduce the quality of life. Delirium also causes sleep disturbances, headaches and not infrequently dizziness.The patient feels tired and exhausted and is no longer able to perform heavy physical activities. Attention is also reduced by delirium, so that there are disturbances in concentration. In most cases, the symptom negatively affects social contacts and personal environment. Due to the clouding of consciousness, coma can even occur. However, this case often occurs only in cases of drug abuse and can be resolved by withdrawal. If delirium is caused by an infection or a severe inflammation, medical treatment is necessary and usually leads to success. In many cases, delirium is diagnosed late by a physician, making treatment more difficult. Especially during withdrawal, delirium can lead to life-threatening situations that require medical monitoring.
When should you see a doctor?
Unusual states of mental confusion generally need to be evaluated and treated by a physician. In many cases, those affected are dependent on help from people in their close environment. Part of the clinical picture of delirium is that the ill people often do not sufficiently understand what is happening around them or where they are at the moment. As soon as orientation is lost for several minutes or there are unusual disturbances of memory, a doctor is needed. If sleep disturbances occur for several days or weeks for reasons that cannot be understood, or if there are interruptions in psychomotor activity, medical examinations should be initiated. People who suffer from epileptic seizures are well advised to have preventive examinations at regular intervals. If fever persists for several days, this is considered egenetic and must also be investigated. In case of a strong weight loss as well as an undersupply of the organism, a medical control examination is needed. If the affected person is in an alcohol or drug withdrawal, he should be permanently and completely medically observed. At the first signs of complications, it must be possible to intervene to avoid danger to life. In case of disturbances of consciousness, an emergency doctor must be called. This is a life-threatening condition that requires immediate intervention.
Treatment and therapy
Treatment of delirium depends entirely on the cause and progress of the symptoms in question. In general, it is important to respond quickly because delirium may be life-threatening. Especially in elderly patients, it is necessary to rule out possible causes such as exsiccosis or pneumonia early on and begin treatment. The actual therapy can be carried out with various drugs such as clonidine or dexmedetomidine. Neuroleptics as well as benzodiazepines are also used and often provide an improvement of the symptoms. Apart from that, the therapy depends on the cause. A delirium tremens is treated with mentioned drugs, a delirium, which develops as a result of a fracture, can only be remedied after the treatment of the injury. States of agitation resulting from shock or trauma can be treated with haloperidol and similar neuroleptics. In the case of delirium resulting from malnutrition, clinical treatment is essential. In the case of alcohol delirium, it is also necessary to treat the patient in the clinic. Vital signs must be monitored continuously because of the respiratory depressant effect of some drugs.
Outlook and prognosis
Delirium is considered a transient condition in most cases and therefore has a favorable prognosis. Once the cause has been treated and subsides, the symptoms disappear. This does not always require medical treatment. If a state of mental confusion occurs due to alcohol influence, cognitive abilities return with the natural breakdown of alcohol in the blood. Within a day, the patient regains his or her competencies. If the cause is severe, medical care is needed or a life-threatening situation may result. The usually reversible disorder is often a warning signal of the human organism. Therefore, the prognosis of delirium is normally good. Within a few days, the full-blown nature of the disease is reduced. On average, delirium lasts about a week. The prognosis improves with prompt treatment.The underlying disease, on the other hand, may indicate complex disorders and may not be curable. In severe cases, the patient suffers from a degenerative brain disease. In this disease, delirium may last for several weeks and, in the worst case, lead to death. In the case of a severe underlying disease, mental confusion may be a sign of a final stage of the disease. In these affected individuals, it is an irreparable health condition.
Prevention
Delirium can be prevented by identifying and minimizing risk factors. Because abuse of medications, alcohol, or drugs often leads to delirium, it is important to limit the use of these agents. Medications such as antidepressants or heart medications should also only be taken after consultation with a physician. Also, any alcohol or drug withdrawal must always be closely supervised by a physician to minimize the risk of delirium. Elderly people can additionally prevent delirium by making sure they eat a balanced and rich diet. Elderly people are not the only ones who should see a doctor regularly to detect any illnesses that may trigger delirium at an early stage.
Follow-up
Aftercare following delirium includes discussions with the affected person as well as general accompanying measures. Most effective is attention from relatives and physicians, who provide a sense of security. In addition, any difficulties in falling asleep or sleeping through the night must be treated by teaching the patient suitable relaxation techniques. Techniques such as autogenic training, yoga or classical physiotherapy have proven effective. If the symptoms persist, it is advisable to take a natural sleep aid from the field of naturopathy. Effective remedies contain, for example, gaba, St. John’s wort or red oil. In order to avoid the development of anxiety disorders, the affected person must carefully inform himself or herself about delirium. In the case of postoperative confusion, information sheets are usually offered to guide the patient and his or her relatives. Follow-up care also includes workup of the causative condition. Delirium resulting from alcoholism, for example, can only be treated in conjunction with causative therapy. Those affected need comprehensive aftercare adapted to the circumstances of the delirium. In most cases, psychotherapeutic support can significantly reduce the psychological burden and contribute to greater well-being in the patient. Working through delirium is an essential component of self-help.
Here’s what you can do yourself
Whether and what a person can do themselves in the event of delirium depends primarily on its causes. Widespread delirium is due to abuse of alcohol and other mind-altering drugs. Anyone who is addicted to drugs or fears that they are, should therefore seek professional help immediately. The first point of contact is the family doctor. If the drug addiction was triggered by psychological problems, psychotherapy is usually indicated. Self-help groups, such as Alcoholics Anonymous, support those affected during withdrawal. The accompanying symptoms of delirium, in particular perceptual disturbances and hallucinations, often lead to social isolation of the affected person, the psychological consequences of which can exacerbate the underlying disease. Patients should therefore confide in their social environment and openly discuss their illness. Symptoms such as sleep disturbances, headaches or nausea can be combated with over-the-counter medications from the pharmacy, but this should only be done after consultation with the attending physician. Patients suffering from a disturbance of the sense of balance can reduce the resulting risk of accidents by using a wheelchair or a walking aid. If the delirium is due to constant malnutrition or acute vitamin deficiency, dietary adjustments and the use of nutritional supplements are indicated. If the reason for the malnutrition is psychological, the help of a therapist should be sought.
