What are the other Names for this Condition? (Also known as/Synonyms)

• Acute Brain Syndrome causing Delirium
• Metabolic Encephalopathy causing Delirium
• Toxic Psychosis due to Delirium

What is Delirium? (Definition/Background Information)

• Delirium is medical condition that develops due to a variety of factors (underlying conditions) that leave the brain vulnerable to disruption in sending and receiving signals. The condition is most commonly seen in older individuals
• There are 3 types of Delirium:
  • Hyperactive Delirium, which is characterized by restlessness, agitation, rapid mood changes, and hallucinations
  • Hypoactive Delirium, which is characterized by inactivity, sluggish, increased drowsiness, and appearing to be in a daze
  • Mixed Delirium, which is characterized by a mix of both hyperactive and hypoactive Delirium 
• A majority of signs and symptoms of Delirium involve decreased cognitive abilities. The condition may be diagnosed through mental assessments, physical exams, and chemical tests
• Delirium can be treated with both supportive care and medication. The condition is generally short-term and subsides with appropriate treatment. However, in some cases, it may last longer
• The prognosis is generally good, but may be dependent upon various factors. In some cases, Delirium can result in an overall decline in health, which may even result in death

Who gets Delirium? (Age and Sex Distribution)

• Delirium is more commonly seen in older individuals with multiple health conditions
• Delirium affects both males and females and no gender preference is seen
• Individuals of all races and ethnicities can develop Delirium

What are the Risk Factors for Delirium? (Predisposing Factors)

The risk factors for Delirium may include:

• Old age, which is the most important risk factor for Delirium
• Hospitalized patients in nursing homes; which is probably because of multiple health conditions
• Health conditions necessitating intensive medical care or surgery
• Neurological (brain-related) conditions and disorders that include dementia, stroke, Parkinson’s disease, and many other
• History of Delirium in the past
• Visual and/or hearing defects

It is important to note that having a risk factor does not mean that one will get the condition. A risk factor increases ones chances of getting a condition compared to an individual without the risk factors. Some risk factors are more important than others.

Also, not having a risk factor does not mean that an individual will not get the condition. It is always important to discuss the effect of risk factors with your healthcare provider.

What are the Causes of Delirium? (Etiology)

Overall, the cause of Delirium is due to a variety of factors that leave the brain vulnerable to disruption in sending and receiving signals. Sometimes, there may be a single factor, or there could be multiple factors, or even no identified factor resulting in Delirium.

Some of the identified factors that are known to cause Delirium include:

• Alcohol or drug withdrawal
• Drug abuse
• Certain medications for mood disorders, sleep, allergies, spasms/convulsions, or asthma
• Chemical disturbances, such as electrolyte imbalance, or metabolic imbalances
• Infections of the urinary tract or respiratory tract
• Certain poisons/toxins
• High fever due to acute infection (in children)
• Poor nutrition or dehydration
• Sleep deprivation
• Large amount of stress (emotional or mental)

What are the Signs and Symptoms of Delirium?

Delirium signs and symptoms seem to revolve around certain quick changes in an individual’s mental state that takes place in an uncontrolled fashion. The effects can begin over a few hours or a few days and can change rapidly through the hour or day.

The general signs and symptoms of Delirium are as follows:

• Change in alertness (more in the morning and less at night)
• Disrupted sensation and perception; disrupted concentration
• Disrupted level of consciousness/awareness; the short-term memory may be affected
• Disrupted movements
• Altered sleep patterns; drowsiness
• Confusion about time or place
• Disorganized thought processes
• Changes in personality or emotions
• Incontinence (urinary or bowel)

How is Delirium Diagnosed?

The following methods may be used to diagnose Delirium:

• Delirium is diagnosed with mental status assessment to look at awareness, attention, and overall thinking via conversation or specific tests to evaluate cognition
• Physical and neurological exams to check for underlying health conditions and to test vision, balance, coordination, reflexes, and other functions is generally employed
• A healthcare professional may other diagnostic tests, such as blood tests, urine tests, or brain-imaging tests, as necessary to aid in the diagnosis

Many clinical conditions may have similar signs and symptoms. Your healthcare provider may perform additional tests to rule out other clinical conditions to arrive at a definitive diagnosis.

What are the possible Complications of Delirium?

When the illness is more serious, Delirium can lead to the following complications:

• Decreased ability to care for oneself
• Decreased overall performance quality of daily functions
• Decreased ability to interact with others
• Overall decline in health
• Decreased ability to recover from severe illnesses or a surgery
• Increased need for institutional care
• Increased risk of death (especially from Hypoactive Delirium)
• Coma

Besides the above, there may be medication side effects used in the treatment of Delirium.

How is Delirium Treated?

The main treatment goal of Delirium is to first address any underlying condition(s) that is causing the symptoms. Further treatments may then depend entirely on the primary cause of Delirium.

• Any medications currently used by the affected individual may need to be controlled or discontinued in order to ensure positive outcomes
• Professional psychological help can be used to help control unacceptable behavior and disorientation associated with Delirium

Overall, the treatment of Delirium can be broken up into the following 2 categories:

• Supportive care that may include:
  • Providing fluids
  • Assisting movements
  • Treating pain
  • Treating incontinence
  • Increasing comfort levels
  • Avoiding environmental changes
  • Encouraging family engagement and promoting positive attitudes
  • Avoiding use of physical restraints
  • Use of professional help to calm the mind
• Medications:
  • Monitoring drugs that may cause Delirium
  • Use of medications to deal with the wide variety of symptoms associated with psychotic episodes
  • To control the underlying condition that caused Delirium

Generally, individuals in overall better health and more stable mental status tend to recover better or faster from Delirium. However, individuals with other more devastating/demoralizing underlying illnesses may never fully return to fully functional levels, such as they were before the onset of Delirium.

How can Delirium be Prevented?

Overall, the best way to treat Delirium is to prevent it from occurring in the first place. This can include closely monitoring preexisting conditions that have a high tendency to lead to Delirium, especially in the elderly adults.

In addition, paying attention to the following factors can have a substantial positive effect on preventing Delirium:

• Assisting actively in orienting individuals who are cognitively impaired, in order for them to better grasp time and place. These could include practices such as increasing the number of clocks, calendars on display; providing the individuals with charts that show important contact information, etc.
• Waking individuals up and getting their days started as early as possible; establishing a healthy sleep-wake cycle
• Decreasing the use or dependence on psychoactive drugs by resorting to other non-drug therapies
• Increasing sensory input and engagement (such as by providing proper eyeglasses or hearing aids)
• Increasing the amounts of fluids given so that dehydration does not occur

What is the Prognosis of Delirium? (Outcomes/Resolutions)

• Generally, Delirium is a short-term condition that goes away with suitable treatment. In such cases, the prognosis is very good
• However, the condition can persist for longer period of time (especially in older individuals) and has been seen to last from weeks to months
• Overall, a full recovery is mostly seen, although the extent of recovery depends on factors such as age, underlying cause of the condition, severity, and treatment response
• Delirium has been associated with a higher risk for complications among hospitalized individuals (including of death)
• Also, the presence of Delirium in an individual with other medical conditions can complicate the underlying condition and worsen the overall prognosis

Additional and Relevant Useful Information for Delirium:

• Studies indicate that nearly 80% of individuals experience Delirium near the end of their life
• Some reports indicate that about one-third of the individuals over 70 years old in a hospitalized setting may suffer from Delirium