Delirium

DisclaimerThis page is not here to be used as a self-diagnosis, self-identification, or promotion - it's simply here to be informational. Whether or not one self-diagnoses, self-identifies, and/or seeks a professional diagnosis is up to them.

**Delirium** is a disturbance in mental abilities that results in confused thinking and reduced awareness of the environment. Delirium is more common in older adults, especially those with dementia. Delirium is more severe than having minor problems with memory and understanding as one gets older.

### Delirium vs Dementia

Delirium and dementia have some similarities, but they are not the same.

* Delirium mostly affects an individual's attention, dementia affects memory.
* Delirium is a temporary state that begins suddenly, dementia is long-term and usually begins gradually and worsens over time.

## Signs & Symptoms

Signs and symptoms of delirium usually begin over a few hours or a few days. Symptoms tend to be worse during the night when it's dark and things look less familiar.

* Reduced awareness of the environment.
	+ An inability to stay focused on a topic or to switch topics.
	+ Getting stuck on an idea rather than responding to questions or conversation.
	+ Being easily distracted by unimportant things.
	+ Being withdrawn, with little to no activity or little response to the environment.
* Cognitive impairment.
	+ Poor memory, particularly of recent events.
	+ Disorientation.
	+ Difficulty speaking or recalling words.
	+ Rambling or nonsense speech.
	+ Difficulty reading or writing.
* Behavior changes
	+ Hallucinations.
	+ Restlessness, agitation or combative behavior.
	+ Calling out, moaning or making other sounds.
	+ Being quiet and withdrawn, especially in older adults.
	+ Slowed movement or lethargy.
	+ Disturbed sleep habits.
	+ Reversal of night-day sleep-wake cycle.
* Emotional disturbances.
	+ Anxiety, fear or paranoia.
	+ Depression.
	+ Irritability or anger.
	+ Euphoria.
	+ Apathy.
	+ Rapid and unpredictable mood shifts.
	+ Personality changes.

## Types of Delirium

### Hyperactive Delirium

An individual with hyperactive delirium may:

* Seem restless.
* Be agitated.
* Resist personal care or respond aggressively to it.
* Seem unusually vigilant.

Someone with hyperactive delirium can easily get very distressed due to not understanding where they are or losing track of time. They may have delusions or hallucinations that carers are trying to harm them.

### Hypoactive Delirium

An individual with hyperactive delirium may:

* Seem restless.
* Be agitated.
* Resist personal care or respond aggressively to it.
* Seem usually vigilant.

It can be easy to not notice that someone has hypoactive delirium, because they may be very quiet.

### Mixed Delirium

An individual with mixed delirium has symptoms of hyperactive delirium at times and symptoms of hypoactive delirium at other times. They will switch between symptoms over the day or from one day to the next.

## Causes

Delirium can often be traced to one or more contributing factors, such as severe or chronic illness, changes in metabolic balance, medication, infection, surgery, or alcohol or drug intoxication or withdrawal.

Common causes are:

* A urine or chest infection.
* Having a high temperature.
* Side-effects of medications.
* Dehydration.
* Live or kidney problems.
* Suddenly stopping drugs or alcohol.
* Major surgery.
* Epilepsy.
* Brain injury or infection.
* Terminal illness.
* Constipation.
* Being in an unfamiliar place.

Anyone can get delirium, but the following factors put individuals at higher risk:

* Dementia.
* Aged over 65.
* Frailty.
* Multiple medical conditions.
* Poor hearing or vision.
* Taking multiple medications.
* Having already had delirium in the past.

## Treatment

Delirium is treated first by addressing the medical problem(s) that have caused it. Doctors will also review the individual's medications and stop any non-essential drugs that may be linked to delirium.

A supportive, calm environment can also help someone recover from delirium.

* Talking calmly to the individual in short clear sentences, reassuring them as to where they are and who they are.
* Supporting the individual with familiar objects from home.
* Making sure that any hearing aids and glasses are clean and working and that the individual is wearing them.
* Setting up a 24-hour clock and calendar that the individual can see clearly.
* Helping the individual develop a good sleep routine.
* Reassuring the individual if they have delusions.
* Supporting the individual to be active as soon as they safely can.
* Helping the individual eat and drink regularly.
* Not moving the individual unnecessarily.

## References

1. https://www.mayoclinic.org/diseases-conditions/delirium/symptoms-causes/syc-20371386
2. https://www.alzheimers.org.uk/get-support/daily-living/delirium
3. https://www.rcpsych.ac.uk/mental-health/problems-disorders/delirium
4. https://my.clevelandclinic.org/health/diseases/15252-delirium