Delirium

by Ms Neha Bhatt, Lecturer , department of psychiatriy

1. Delirium BY Ms Neha Bhatt Department of psychiatry

2. Delirium Delirium is an acute organic mental disorder characterized by impairment of consciousness , disorientation and disturbance in perception and restlessness . It is a serious disturbance in mental abilities that results in confused thinking and reduced awareness of environment. The start of delirium is usually rapid — within hours or a few days

3. Causes Delirium occurs when the normal sending and receiving of signals in the brain become impaired. Possible causes include: Certain medications or drug toxicity Alcohol or drug abuse or withdrawal Medical condition Metabolic imbalances Severe, chronic or terminal illness

4. Causes Fever and acute infection, particularly in children Exposure to a toxin Malnutrition or dehydration Sleep deprivation or severe emotional distress Pain Surgery or other medical procedures that include anesthesia

5. Causes Several medications or combinations of drugs can trigger delirium, including some types of: Pain drugs Sleep medications Medications for mood disorders, such as anxiety and depression Allergy medications (antihistamines) Drugs for treating spasms or convulsions Asthma medications

6. Symptoms Signs and symptoms of delirium usually begin over a few hours or a few days. They often fluctuate throughout the day, and there may be periods of no symptoms. Symptoms tend to be worse during the night when it's dark and things look less familiar.

7. Symptoms Reduced awareness of the environment This may result in: An inability to stay focused on a topic or to switch topics Getting stuck on an idea rather than responding to questions or conversation Being easily distracted by unimportant things Being withdrawn, with little or no activity or little response to the environment

8. Symptoms Poor thinking skills (cognitive impairment) Poor memory, particularly of recent events Disorientation Difficulty speaking or recalling words Rambling or nonsense speech Trouble understanding speech Difficulty reading or writing

9. Symptoms Behavior changes- This may include: Hallucinations Restlessness, agitation Calling out, making other sounds Being quiet and withdrawn — especially in older adults Slowed movement or lethargy Disturbed sleep habits Reversal of night-day sleep-wake cycle

10. Symptoms Emotional disturbances - This may appear as: Anxiety, fear or paranoia Depression Irritability or anger A sense of feeling elated (euphoria) Apathy Rapid and unpredictable mood shifts Personality changes

11. Types of delirium Hypoactive delirium.  This may include inactivity or reduced motor activity, sluggishness, abnormal drowsiness. Hyperactive delirium. This may include restlessness , agitation, rapid mood changes or hallucinations. Mixed delirium.  This includes both hyperactive and hypoactive symptoms. The person may quickly switch back from hyperactive to hypoactive states.

12. Risk factors Brain disorders such as dementia, stroke or Parkinson's disease Older age Previous delirium episodes Visual or hearing impairment Having multiple medical problems

13. Tests and diagnosis Mental status assessment Physical and neurological exams- A neurological exam — checking vision, balance, coordination and reflexes — can help determine if a stroke or another neurological disease is causing the delirium. Blood test Urine examination CT, MRI

14. Treatments The first goal of treatment for delirium is to address any underlying causes or triggers — for example, by stopping use of a particular medication or treating an infection. Treatment then focuses on creating the best environment for healing the body and calming the brain.

15. Treatments Supportive care Supportive care aims to prevent complications by: Protecting the airway Providing fluids and nutrition Assisting with movement Treating pain Addressing incontinence Avoiding use of physical restraints and bladder tubes Avoiding changes in surroundings and caregivers when possible Encouraging the involvement of family members or familiar people

16. Medications Talk with the doctor about avoiding or minimizing the use of drugs that may trigger delirium. Certain medications may be needed to control pain that's causing delirium. Fluid and nutrition should be given carefully because the patient may be unwilling or physically unable to maintain a balanced intake. For the patient suspected of having alcohol toxicity or alcohol withdrawal, therapy should include multivitamins, especially thiamine.

17. Coping and support Promote good sleep habits To promote good sleep habits: Provide a calm, quiet environment Keep inside lighting appropriate for the time of day Plan for uninterrupted periods of sleep at night Help the person keep a regular daytime schedule Encourage self-care and activity during the day

18. Coping and support Prevent complicating problems by: Giving the person the proper medication on a regular schedule Providing plenty of fluids and a healthy diet Encouraging regular physical activity Getting treatment for potential problems, such as infection or metabolic imbalances, early

19. Coping and support Caring for the caregiver Providing regular care for a person with delirium can be scary and exhausting. Take care of yourself, too. Consider joining a support group for caregivers. Learn more about the condition. Share caregiving with family and friends who are familiar the person so you get a break. Organizations that may provide helpful information are National Family Caregivers Association and the National Institute on Aging.

20. Nursing intervention Providing safe environment Alleviating patients fear and anxiety Meeting the physical needs of patients Facilitate orientation