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.
It is recommended that physical restraints be avoided with patients presenting delirium, as this can worsen the condition.
Delirium and Elderly Patients
Delirium is particularly common among older patients. When an elderly patient is admitted into the intensive care unit (ICU), doctors should monitor for delirium. Preventing this condition will ensure that further negative consequences do not result. Doctors can use a checklist to decide whether a patient's symptoms match those associated with delirium.
This is especially important in elderly patients as delirium can be mistaken for other conditions and thus not properly treated. If left untreated, delirium can lead to further hospitalization or institutionalization, dementia, permanent cognitive impairment, and even death.
Lesson Summary
Delirium is a serious condition that can be caused by withdrawal, illness, or infection. It is characterized by a sudden onset and includes symptoms like hallucinations, confusion, and agitation.
It's important for medical professionals to manage delirium in patients. This can take a number of different forms, including antipsychotic medication or adjusting the stimuli in a patient's room. Doctors should try to help orient patients by reminding them where they are and avoid disruptions like changing a patient's room.
Delirium can be treated, but it is important that doctors identify it early on in a patient. Then, doctors can manage a patient's environment to ensure that stimuli are not exacerbating the condition. Depending on the patient, a combination of somatic interventions, such as medication, and environmental ones, like providing cognitive stimulation, might also be prescribed to manage delirium.
Educating family members and using preventative measures can go a long way to making sure delirium is properly managed.
