Delirium

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Delirium

 

Delirium acts against mental and emotional stability, causing confusion and a distorted, or narrowed perception of the external world. The time-sense often is disrupted. Unlike dementia, with which it's often equated, delirium's onset is frequently rapid, manifesting in hours or several days. Worse, over 50% of cases are misdiagnosed. Symptoms can include uncharacteristic and/or bizarre behavior, uncertainty about established routines and places, and general disorientation. Risk factors are well-known, primarily pre-existing brain disease, infection, stress and injury, and medications. Aged persons and, oddly, children are most susceptible to the condition.

To the person suffering delirium, losing total or even partial orientation is frightening. Imagine entering the familiar comfort of your living room, lowering onto the couch, and abruptly realizing you're in someone else's home. Such is the emotional shock of delirium's fluctuating nature. Worsening toward night-time hours and appropriately called sundowning, this distress can be greatly lessened by a loved one or caregiver whose presence can anchor the sufferer to their environment.

Delirium, beyond causing distortion of the time-sense and an inability to focus, or sometimes even disengage attention, can affect short-term memory. It is speculated that vitamin B-12 deficiency plays a role in memory loss (and other ills including weakness, depression, and constipation). Sadly, research reveals that as many as 83% of intensive care unit patients experience delirium, and that memories of the delirium itself can persist for one year or longer. Further investigation into whether general disorientation "mimics" memory loss is underway.

While sleep disturbance is a known contributor to delirium, it features prominently in persons already experiencing an episode. The sleep-wake cycle is fragmented, and/or altogether reversed, and associated with disruption of circadian rhythm, our built-in regulator sensitive to external and internal changes.

Initial treatments for delirium involve looking for underlying and prosaic triggers, such as recent changes in medications, any kind of infection, major job and/or family stress. Once these factors are reviewed, treatment centers on providing a comforting environment, one containing an analog clock and large paper calender. Special attention must be directed toward ensuring against complications by monitoring and protecting the airway, maintaining hydration, nutrition, management of pain and incontinence, plus assisting the patient with walking and other movement while remaining vigilant for abrupt changes in behavior.

Drugs may be required to calm an individual whose disorientation induces paranoia, fear, or—less likely—hallucinations. If these states are present when medical evaluations or treatment are required, medication can protect the patient from self-injury or harming others. After the delirium clears,  medication dosages commonly are lessened and often altogether stopped.

As both technology and diagnostic methods progress, the field of psychiatry evolves into specialized disciplines, making education of patients and families ever more crucial. Even though individuals suffering from delirium will have differing capacities for understanding the condition, it remains of utmost importance that mental health professionals and other caregivers reassure the patient and loved ones that the symptoms are medically understood, and delirium is usually temporary.

References:

  1. http://psychiatryonline.org/pb/assets/raw/sitewide/practice_guidelines/guidelines/delirium.pdf
  2. http://www.mayoclinic.org/diseases-conditions/delirium/basics/treatment/con-20033982
  3. https://www.ncbi.nlm.nih.gov/pubmed/9894731
  4. https://bmcnurs.biomedcentral.com/articles/10.1186/s12912-015-0070-1

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