Delirium is a potentially reversible medical condition that usually begins suddenly. It causes a person to be unable to concentrate and become confused, disoriented, and unable to think clearly.
DELIRIUS: General | Symptoms | Causes | Diagnosis | Treatment | Delirium or psychosis | Delirium or dementia | Dementia | Questions and Answers | Sources/references
Although delirium and dementia are often discussed together in medical textbooks, they are very different. Delirium means a sudden, usually reversible, change in mental state characterized by confusion and disorientation. Dementia is a chronic, slowly progressing disease, the result of which is memory loss and a severe decline in all aspects of mental functioning; unlike delirium, dementia is usually irreversible.
Symptoms
Delirium can start in many ways, and the case can sometimes be challenging to identify. People's behavior is different, but roughly, it is similar to the behavior of a person who gets drunk. A meaningful sign of delirium is the inability to pay attention to something. Delirious people cannot concentrate, so they have difficulty processing new information and cannot remember recent events.
Image: Treatment for delirium depends on the underlying cause.
Almost everyone is disoriented in time and at least partially confused about where they are. They think confusedly, wordy, or even think incoherently. In complex cases, the patient sometimes does not know who he is. Such patients can be frightened by bizarre hallucinations in which they see things or people that are not there.
Some become paranoid and believe that strange things are happening (delusions). Delirious people react to their problems in different ways: some become so quiet and withdrawn that those around them sometimes do not even realize they are delusional; others become agitated and try to fight their apparitions or delusions.
Video content: Delirium - causes, symptoms, diagnosis, treatment, and pathology.
When delirium is caused by medication or drugs, behavior often changes in different ways depending on the substance. For example, people poisoned by sleeping pills often become very withdrawn, and those poisoned by amphetamines can become aggressive and hyperactive.
Delirium can last several hours, days, or even longer, depending on its severity and the patient's other medical condition. It often gets worse at night (this is called the setting sun phenomenon). Sooner or later, the delirious patient will sink into a restless sleep; sometimes, delirium can even progress into a coma.
Causes
Delirium is an abnormal mental state (not a disease) with many symptoms that indicate reduced mental functioning. Delirium can cause hundreds of medical conditions, ranging from simple dehydration to drug poisoning or life-threatening infections.
Common causes of delirium:
- Alcohol, drugs, and poisons.
- Toxic effects of drugs.
- Abnormal blood concentrations of electrolytes, salts, and minerals, e.g., calcium, sodium, or magnesium, are the result of medication, dehydration, or illness.
- Acute infection with fever.
- Normal pressure hydrocephalus is a medical condition in which the cerebrospinal fluid that cushions the brain is not reabsorbed quickly enough, putting pressure on the brain.
- Subdural hematoma - a blood collection under the skull that can press on the brain.
- Meningitis, encephalitis, syphilis - infections affecting the brain.
- Deficiency of thiamin and vitamin B12.
- Thyroid diseases, either due to an underactive or overactive thyroid.
- Brain tumors - some sometimes cause confusion and memory problems.
- Fractures of the hip and long bones.
- Impaired heart or lung function results in a lack of oxygen or access to carbon dioxide in the blood.
- Brain stroke.
Most often, delirium affects the elderly and those whose brains have already been damaged, e.g., very seriously ill patients, those taking medication or drugs that alter the mind or behavior, and people with dementia.
Diagnosis
Doctors can easily recognize delirium that has passed the mild phase. Because delirium can be a sign of many serious illnesses, some of which can quickly lead to death, doctors try to determine the cause as soon as possible. First, they try to distinguish delirium from mental illness.
Image: Doctors try to distinguish delirium from mental illness.
In older adults, doctors try to distinguish delirium from dementia by finding out what mental state the patient was in before the onset of delirium. However, patients who have dementia can also become delirious.
Treatment
Treatment for delirium depends on the underlying cause. For example, we treat infections with antibiotics, fever with other drugs, and abnormal concentrations of salt and minerals in the blood with fluid and salt regulation. People who are highly agitated or who have hallucinations should be prevented from harming themselves or their caregivers. Hospitals sometimes use padded barriers. Benzodiazepine medications, such as diazepam, triazolam and temazepam.
Antipsychotic drugs, e.g., haloperidol, thioridazine, and chlorpromazine, are usually only given to people who are aggressively paranoid or highly fearful or who cannot be sedated with benzodiazepines. Hospitals use barricades only when there is no other way out, and doctors are careful about prescribing drugs, especially for older people, because barricades or drugs can cause further agitation or confusion and mask the underlying problem. But if the delirium was triggered by alcohol, doctors give benzodiazepines until the agitation passes.
Is this delirium or psychosis?
Delirium and phimosis are two conditions that affect mental health, but they have slightly different characteristics. Delirium is a state of confusion and disorientation, often accompanied by hallucinations, agitation, and reduced awareness of surroundings. It is usually associated with acute physical illnesses such as infections, dehydration, or side effects from medication.
Video content: Delirium or dementia?
Psychosis is a condition characterized by a loss of contact with reality. The person may experience hallucinations, delusions, and disturbances in thinking and feeling. This condition can be associated with various mental illnesses, such as schizophrenia, bipolar disorder, or major depression.
| Common signs of delirium (physical illness) | Common signs of psychosis (mental illness) |
| Confusion about the current time, date, place, or identity. | The patient is usually aware of time, place, and identity. |
| Trouble maintaining attention. | Ability to sustain attention. |
| Fresh memory loss. | Illogical thinking, but keeping the memory fresh. |
| Inability to think logically or do simple calculations. | Reserved ability to compute. |
| Fever or other signs of infection. | Anamnesis of previous psychiatric disorders. |
| Employment unrest is usually variable. | Employment unrest is often constant and unchanging. |
| (Possible) hallucinations are usually visible. | (Possible) hallucinations are primarily auditory. |
Although delirium and psychosis are both associated with disturbances in perception and thinking, their etiology is different, and so are their treatments. Delirium is usually a short-term condition that resolves when the underlying cause is addressed, whereas psychosis often requires long-term treatment and management. It is essential that both conditions are treated professionally and that appropriate medical assistance is provided.
Is this delirium or dementia?
Delirium and dementia are both associated with impaired cognitive function but have slightly different characteristics. Delirium is an acute state of confusion and disorientation that usually develops rapidly and is often reversible. A person with delirium may experience hallucinations, disturbances in attention, confusion, disorientation, and mood swings. It is often associated with acute physical illnesses such as infections, injuries, dehydration, or drug side effects.
Dementia is a chronic progressive condition that involves the loss of cognitive abilities, including memory, thinking, orientation, language, judgment, and the ability to perform daily activities. It is often associated with age and diseases such as Alzheimer's disease, vascular dementia, Lewy bodies, or frontotemporal dementia.
Comparison of delirium and dementia:
| Delirium | Dementia |
| It develops suddenly. | Developing slowly. |
| Lasts several days to several weeks. | It can be permanent. |
| It is associated with the consumption or withdrawal of drugs or drugs, with severe illness and metabolic problems. | The patient may be otherwise healthy. |
| Almost always worse at night. | It is often worse at night. |
| The patient cannot concentrate. | Escape attention. |
| Consciousness fluctuates from lethargy to agitation. | Consciousness is often reduced but does not show large fluctuations. |
| Orientation in the environment is different. | Orientation in the environment is disturbed. |
| Speech is slow, often incoherent, and inappropriate. | The patient sometimes has trouble finding the right word. |
| Memory is messy and confused. | Loss of memory, especially for recent events. |
The critical difference between delirium and dementia is their nature, duration, and causes. Delirium is usually acute and reversible, while dementia is chronic and progressive. Delirium is often associated with acute physical illnesses, while dementia is often the result of degenerative or vascular brain diseases. Both conditions require appropriate medical treatment and management.
Dementia
Dementia is a decline in mental abilities that usually progresses slowly and can lead to impairments in memory, thinking, judgment, and the ability to direct attention and learn, as well as the deterioration of personality.
Image: Dementia is a much more severe decline in mental abilities.
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Dementia can develop suddenly in young people when a severe injury, disease, or poison (e.g., carbon monoxide) destroys brain cells. However, it usually develops slowly in people over the age of 60. However, dementia is not a normal part of aging. Aging in all people causes changes in the brain, due to which people lose some memory - especially short-term memory - and can no longer learn quickly.
These regular changes do not affect the ability to function normally. Forgetfulness in older people is sometimes called benign age-related forgetfulness and is not necessarily a sign of dementia or early Alzheimer's disease. Dementia is a much more severe decline in mental abilities that worsens over time. While aging people may typically forget some details, people with dementia may forget recent events entirely.
Causes
The most common cause of dementia is Alzheimer's disease. We do not know what causes Alzheimer's disease, but hereditary factors are important - the disease appears to run in some families. It is caused or influenced by several specific genetic abnormalities.
In Alzheimer's disease, parts of the brain degenerate, cells die, and the remaining cells' responsiveness to many chemical substances that transmit signals decreases. Abnormal tissues, called senile plaques and neurofibrillary tangles, and abnormal proteins appear in the brain and are identified by doctors at autopsy.
The second most common cause of dementia is consecutive strokes. Individual strokes are small, so they don't leave much (or any) immediate paralysis, and rarely the kind of paralysis that results from larger strokes.
Questions and answers
Can delirium be dangerous?
Delirium can be serious and is associated with severe illness and physical stress. Controlling the underlying cause can help resolve delirium[1].
Is delirium the same as psychosis?
Delirium and phimosis are two different conditions that affect mental health, but they have slightly different characteristics. Delirium is a state of confusion and disorientation, often accompanied by hallucinations, agitation, and reduced awareness of surroundings. It is usually associated with acute physical ailments such as eye diseases, dehydration, or side effects of medications.
Image: Psychosis is a condition characterized by a loss of contact with reality.
.jpg)
Psychosis is a condition characterized by a loss of contact with reality. The person may experience hallucinations, delusions, and disturbances in thinking and feeling. This condition can be associated with various mental illnesses, such as schizophrenia, bipolar disorder, or major depression.
Can anyone get delirium?
Delirium can be triggered by a severe medical condition such as an infection, certain medications, and other causes such as drug withdrawal or poisoning. Elderly patients over the age of 65 have the highest risk of developing delirium. People with previous brain disease or brain injury are also at risk[2].
Is delirium curable?
Doctors diagnose delirium based on symptoms and physical exam results and use blood, urine, and imaging tests to determine the cause. Immediate treatment or treatment of the condition causing delirium usually cures it[3].
Is the affected person aware that they have delirium?
A person with delirium may not be aware of the changes and often cannot describe them[4].
Sources and references
Extensive health manual for home use, Youth Book Publishing House
- Delirium - https://www.hopkinsmedicine.org/
- Patient education: Delirium (Beyond the Basics) - https://www.uptodate.com/
- Delirium - https://www.msdmanuals.com/
- Delirium - https://my.clevelandclinic.org/
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