Lone Sloane: Delirius Vol. 2

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We now know delirium can cause permanent damage to the brain. Some sufferers never return to normal. We also know that Alzheimer’s disease progresses more rapidly when sufferers get delirium. What causes it? Relatives can help by reminding the patient of what is happening, and where, to re-orientate them. Hospital environments can be designed to be safe for older patients with confusion. For example, providing natural light helps to keep day-night rhythms more normal, allowing patients to wander without risking harm. Physical restraints Severe alcohol withdrawal that causes sudden mental and nervous-system changes can have similar symptoms to delirium; the condition is called Delirium Tremens. Intoxication with various licit and illicit drugs can also cause acute confusion and hallucinations. Delirium can be a frightening condition for those who have it, together with their family and carers. Not everyone remembers delirium, but those that do may find the memories distressing.

Some medicines taken alone or taken in combination can trigger delirium. These include medicines that treat:Hyperactive delirium. This may be the easiest type to recognize. People with this type may be restless and pace the room. They also may be anxious, have rapid mood swings or see things that aren't there. People with this type often resist care. Antipsychotic medications (the kind used to treat schizophrenia) have been used in low doses to help with symptoms of hyperactive delirium. But a recent Australian trial in palliative care patients found these medications were not only ineffective, but also detrimental to the patients. This reinforces the fact that medications should take second place to keeping the patient safe. The nurses told me that my grandmother had been up all night, wandering around the ward and trying to leave. However, when I visit her on the ward in the daytime, she is nice and quiet and seems OK.” Physical changes Treating delirium requires treating the trigger, such as stopping the medication causing the side effects of delirium. Unfortunately, though, the delirium can persist well after the trigger has gone. Alcohol withdrawal delirium, or delirium tremens, is a form of the condition that can happen to people who drink large amounts of alcohol for many years. If someone who regularly drinks a lot suddenly tries to stop drinking, severe withdrawal including delirium is possible.

Attention. The ability to stay focused or maintain focus is impaired with delirium. A person in the early stages of dementia remains generally alert. Someone with dementia often isn't sluggish or agitated. certain medications, such as sedatives, blood pressure medications, sleeping pills, and pain relievers Mayer SA, et al. Delirium and amnesia. In: On Call Neurology. 4th ed. Elsevier; 2021. https://www.clinicalkey.com. Accessed Sept. 19, 2022. Symptoms of delirium usually begin over a few hours or a few days. They typically occur with a medical problem. Symptoms often come and go during the day. There may be periods of no symptoms. Symptoms tend to be worse at night when it's dark and things look less familiar. They also tend to be worse in settings that aren't familiar, such as in a hospital.Many health professionals use the Confusion Assessment Method (CAM) to diagnose or rule out delirium. This is a screening test that helps them observe whether or not:

As you get older, you are more likely to have delirium. People who are over 80 years old and have been diagnosed with some type of dementia are particularly at risk. However, delirium can happen in younger people as well, especially if they are critically ill or after surgery. Symptoms of delirium A healthcare professional can diagnose you with delirium. Usually, this is done by a doctor or, in some cases, a nurse. The hypoactive form, with a drowsy, sleepy patient who is slow to respond, is more easily missed – or dismissed for the reasons mentioned before. This kind is more dangerous.The clinician will observe your symptoms and examine you to see how you think, speak, and move. Confusion assessment method Depending on the cause of the delirium, treatment may include taking or stopping certain medications. In hospital, you can tell the nurse or doctor looking after the person about the symptoms you have noticed. At home, you can talk to a GP. Jankovic J, et al., eds. Delirium. In: Bradley and Daroff's Neurology in Clinical Practice. 8th ed. Elsevier; 2022. https://www.clinicalkey.com. Accessed Sept. 19, 2022.

Delirium can have different causes. We may need to do medical tests to help decide what treatment is needed.The doctors and nurses test for and manage any causes of delirium that can be treated. Examples are: People with other serious, long-lasting or terminal illnesses may not regain the thinking skills or function that they had before the onset of delirium. Delirium in seriously ill people is more likely to lead to: When a person leaves hospital after delirium, they may need more support than usual. They may be at higher risk of falls and need some changes in the home to make sure that their environment is safe. The earlier-mentioned Australian study found patients with delirium were five times more likely to die if they came to hospital already with delirium, and 30 times more likely to die if it developed during their stay.