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How to Manage Patient Delirium

Instructor: Emily Cummins
In this lesson, we'll talk about the condition known as delirium. This is a state of mental disturbance that is caused by serious illness, infection, or withdrawal. We'll talk about how medical professionals manage patients who are delirious.

What is Delirium?

Have you ever heard the expression 'I'm deliriously happy'? This is a somewhat tongue-in-cheek way of expressing extreme happiness, but delirium is actually an actuate psychiatric condition involving severe mental disturbance. Basically, patients suffering from delirium often have scary hallucinations, might be agitated or restless, and are not aware of where they are or what is happening.

Delirium comes on suddenly, generally developing within a few hours or days. While it can be treated, it is considered very serious and requires immediate medical attention. Delirium is accompanied by problems with vital signs, and patients with delirium generally appear very ill.

Delirium is especially common in elderly patients in the intensive care unit of a hospital. Let's now talk about what causes delirium.

What Causes Delirium?

Delirium can be caused by a number of different things. One cause is serious illness or infection. Patients who have sepsis (a condition where the body's response to infection damages tissues or organs) or other serious infections can experience delirium. Kidney infections and related autoimmune diseases can also cause delirium. Similarly, severe alcohol withdrawal can also cause delirium.

It's important to note that delirium is different from psychosis or dementia, even though some of the symptoms appear to be similar. Psychosis is a condition where someone loses touch with reality. It is a mental illness, and these patients generally do not have a sudden onset of symptoms and it is not caused by infection or fever.

Delirium is a temporary condition, caused by something that can be treated by medical professionals (like a very high fever). Psychosis is the result of a more serious and lasting mood disorder, such as schizophrenia, which has more complex biological and environmental causes.

A patient presenting symptoms of delirium is likely to be more disoriented than a patient presenting symptoms of psychosis. A patient with delirium will also appear very physically ill.

Dementia is a chronic, ongoing condition that worsens over time. It's essentially the brain deteriorating.

Managing Patient Delirium

Now that we have a bit more background, let's talk about how medical professionals manage patient delirium. The American Psychiatric Association (APA) has several guidelines and interventions for treating patients who present with delirium.

The APA notes that, first and foremost, psychiatric intervention is necessary. This includes making sure that urgent medical needs are taken care of. For example, if a serious infection is causing the delirium, the first task for doctors is treating this underlying condition. It is also recommended that medical professionals educate a patient's family about delirium. Family members should learn to identify symptoms of delirium.

Next, environmental interventions involve doctors and other medical professionals creating atmospheres that help a patient remember where he or she is. This might entail changing things in the patient's environment to reduce confusion or disorientation. Environmental interventions also include doing cognitive activities that will help stimulate a patient's mental state. It is also recommended that patients be mobile. For example, if a patient is bedridden, medical professionals should develop bedside motor activities.

It is also important to make sure that nothing in a patient's room is overstimulating. For example, noise should be low. Vision impairment can also worsen delirium, so patients should have proper eye gear, if needed.

Next, doctors might undertake somatic interventions. This might involve using antipsychotic medication to treat a patient with delirium. However, because these medications can produce side effects, it is important that patients are carefully monitored. Patients should also be monitored for dehydration as serious dehydration can cause delirium.

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