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Delirium

Acute confusional state; Acute brain syndrome

 

Delirium is sudden severe confusion due to rapid changes in brain function that occur with physical or mental illness.

Causes

 

Delirium is most often caused by physical or mental illness, and is usually temporary and reversible. Many disorders cause delirium. Often, these do not allow the brain to get oxygen or other substances. They may also cause dangerous chemicals (toxins) to build up in the brain.

Causes include:

  • Alcohol or medicine overdose or withdrawal
  • Drug use or overdose
  • Electrolyte or other body chemical disturbances
  • Infections such as urinary tract infections or pneumonia
  • Severe lack of sleep
  • Poisons

 

Symptoms

 

Delirium involves a quick change between mental states (for example, from lethargy to agitation and back to lethargy).

Symptoms include:

  • Changes in alertness (usually more alert in the morning, less alert at night)
  • Changes in feeling (sensation) and perception
  • Changes in level of consciousness or awareness
  • Changes in movement (for example, may be slow moving or hyperactive)
  • Changes in sleep patterns, drowsiness
  • Confusion (disorientation) about time or place
  • Decrease in short-term memory and recall
  • Disorganized thinking, such as talking in a way that doesn't make sense
  • Emotional or personality changes, such as anger, agitation, depression, irritability, overly happy
  • Incontinence
  • Movements triggered by changes in the nervous system
  • Problem concentrating

 

Exams and Tests

 

The following tests may have abnormal results:

  • An exam of the nervous system (neurologic examination), including tests of feeling (sensation), thinking (cognitive function), and motor function
  • Neuropsychological studies

The following tests may also be done:

  • Blood and urine tests
  • Chest x-ray
  • Cerebrospinal fluid (CSF) analysis (spinal tap)
  • Electroencephalogram (EEG)
  • Head CT scan
  • Head MRI scan
  • Mental status test

 

Treatment

 

The goal of treatment is to control or reverse the cause of the symptoms. Treatment depends on the condition causing delirium. The person may need to stay in the hospital for a short time.

Stopping or changing medicines that worsen confusion, or that are not necessary, may improve mental function.

Disorders that contribute to confusion should be treated. These may include:

  • Anemia
  • Decreased oxygen ( hypoxia )
  • Heart failure
  • High carbon dioxide levels ( hypercapnia )
  • Infections
  • Kidney failure
  • Liver failure
  • Nutritional disorders
  • Psychiatric conditions (such as depression or psychosis)
  • Thyroid disorders

Treating medical and mental disorders often greatly improves mental function.

Medicines may be needed to control aggressive or agitated behaviors. These are usually started at very low dosages and adjusted as needed.

Some people with delirium may benefit from hearing aids, glasses, or cataract surgery .

Other treatments that may be helpful:

  • Behavior modification to control unacceptable or dangerous behaviors
  • Reality orientation to reduce disorientation

 

Outlook (Prognosis)

 

Acute conditions that cause delirium may occur with chronic disorders that cause dementia . Acute brain syndromes may be reversible by treating the cause.

Delirium often lasts about 1 week. It may take several weeks for mental function to return to normal. Full recovery is common, but depends on the underlying cause of the delirium.

 

Possible Complications

 

Problems that may result from delirium include:

  • Loss of ability to function or care for self
  • Loss of ability to interact
  • Progression to stupor or coma
  • Side effects of medicines used to treat the disorder

 

When to Contact a Medical Professional

 

Call your health care provider if there is a rapid change in mental status .

 

Prevention

 

Treating the conditions that cause delirium can reduce its risk. In hospitalized people, avoiding or using a low dosage of sedatives, prompt treatment of metabolic disorders and infections, and using reality orientation programs will reduce the risk of delirium in those at high risk.

 

 

Open References

References

Irwin SA, Pirrello RD, Hirst JM, Buckholz GT, Ferris FD. Clarifying delirium management: practical, evidenced-based, expert recommendations for clinical practice. J Palliat Med . 2013;16:423-435. PMID: 23480299 www.ncbi.nlm.nih.gov/pubmed/23480299 .

Mendez MF, Padilla CR. Delirium. In: Daroff RB, Jankovic J, Mazziotta JC, Pomeroy SK, eds. Bradley's Neurology in Clinical Practice . 7th ed. Philadelphia, PA: Elsevier; 2016:chap 4.

Smith JP, Seirafi J. Delirium and dementia. In: Marx JA, Hockberger RS, Walls RM, et al, eds. Rosen's Emergency Medicine: Concepts and Clinical Practice . 8th ed. Philadelphia, PA: Elsevier Saunders; 2014:chap 104.

 
  • Central nervous system

    Central nervous system - illustration

    The central nervous system is comprised of the brain and spinal cord. The peripheral nervous system includes all peripheral nerves.

    Central nervous system

    illustration

  • Brain

    Brain - illustration

    The major areas of the brain have one or more specific functions.

    Brain

    illustration

    • Central nervous system

      Central nervous system - illustration

      The central nervous system is comprised of the brain and spinal cord. The peripheral nervous system includes all peripheral nerves.

      Central nervous system

      illustration

    • Brain

      Brain - illustration

      The major areas of the brain have one or more specific functions.

      Brain

      illustration

    Tests for Delirium

     
       

      Review Date: 1/5/2016

      Reviewed By: Joseph V. Campellone, MD, Division of Neurology, Cooper University Hospital, Camden, NJ. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.

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