Delirium

Delirium is a temporary but serious life threatening condition that causes severe fluctuation in mental stability and consciousness, leading to decreased awareness of one's environment and confused thinking. The onset of delirium is usually sudden, and there is a noticeable difference in the person's thinking and behavior within a few hours or days.

Since delirium and dementia have similar symptoms, and both conditions can co-exist, it is important to know the difference.

Delirium is a temporary condition that starts suddenly and can cause hallucinations. The symptoms may get better or worse, and can last for a few hours or weeks.

Dementia is a progressive neuro-degenerative disorder that develops slowly and the brain cells degenerate as time progresses, eventually leading to death. Dementia does not cause hallucinations.

The signs and symptoms of delirium can appear in a few hours or days. During this period, there is a fluctuation in the person's mental stability. The person may exhibit symptoms at some times, and appear normal otherwise.

Primary signs and symptoms include:

Reduced awareness of the environment

• Being easily distracted by unimportant things

• Being unable to focus on a specific topic

• Being withdrawn or showing reduced response to the environment

• Being unable to respond in conversation or to questions

Poor thinking skills (cognitive impairment)

• Poor memory, particularly of recent events

• Disorientation, not knowing where one is, or who one is

• Reduced awareness of time or day

• Difficulty in speaking or recalling words

• Rambling or nonsense speech

• Difficulty in reading or writing

Behavior changes

• Seeing things that don't exist (hallucinations)

• Restlessness, agitation, irritability or combative behavior

• Constant feeling of drowsiness and disturbed sleep

• Mood changes or extreme emotions such as fear, anxiety, or anger

Physical symptoms such as changes in heart rate, tremor, agitation, or sleep-cycle-reversal may be seen.

Common causes include severe or chronic medical illness, high dosage of medication, infection(such as urinary tract, or skin and abdominal infections), pneumonia, drug or alcohol abuse.

Other conditions that can increase the risk of delirium are:  

• Fever and acute infection, particularly in children
• Treatment of a particular disease with multiple drugs
• Multiple medical problems or surgeries
• Alcohol, drug abuse or withdrawal

Some medications used for anxiety, depression, Parkinson's disease, asthma or sleep medications can cause delirium.

Delirium may last only a few hours or may persist for several weeks or months. People suffering from other chronic or terminal illness may not regain thinking and reasoning abilities that they had before the onset of delirium. If delirium is not treated or the factors causing delirium are not addressed, then the person may experience:

• Deterioration of health

• Poor recovery from surgery

• Increased risk of death

Diagnosis of delirium is based on the person's medical history, assessment of the person's mental status, physical and neurological exams and other diagnostic tests.

If a family member or friend shows any symptoms of delirium, see a doctor immediately. If the person has dementia, be aware of relatively sudden changes in his or her overall awareness and thinking abilities, which may trigger delirium. Your observations about the person's symptoms, as well as his or her typical thinking, daily habits and activities, will be important for a diagnosis.

Older people recovering in the hospital or living in a long-term care facility are particularly at risk of delirium. Because symptoms can fluctuate and some symptoms are "quiet" — such as social withdrawal or poor responsiveness — delirium may be missed. If you notice signs and symptoms of delirium in a person in a hospital or nursing home, immediately report your concerns to the doctor immediately.

In case of delirium, the root cause needs to be treated. For example, a physical illness like infection can be treated with antibiotics, and the person may recover from delirium.

When a family member or a friend is recovering from delirium, you can help the person by providing emotional support. Here are some suggestions to help the person recover from delirium.

• Set  regular routine for daily activities, to manage the situation
• Encourage the person to exercise or do some physical activity during the day
• Offer warm soothing, non-caffeinated, non-alcoholic beverages before bedtime, to regulate the sleep pattern
• Encourage the patient to refer a clock and calendar for all activities
• Keep familiar or favorite objects around but avoid a cluttered environment
• Keep noise levels and other distractions to a minimum
• Make sure the person takes medicines regularly

Caring for a person person with or at risk of delirium can be quite overwhelming and stressful. You need to take care of your physical and mental health. Getting sufficient sleep, eating nutritious food and also spending some time for your own well being may help in coping with the situation. Also, learning about the disorder will enable you to make informed decisions in helping the person recover from delirium.