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Delirium

Definition

Delirium is a change in mental status. Delirium is marked by extreme, fluctuating changes, including:

Causes

Hundreds of underlying causes can result in delirium. Some of the most common causes include:
Brain Tumor
Brain Tumor
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Risk Factors

Factors that may increase your risk of developing delirium include:

Symptoms

Symptoms usually come on quickly and can last for days, weeks, or longer. They also vary in severity depending on the cause. Symptoms are often worse at night and may include:
Severe symptoms include:

Diagnosis

You will be asked about your symptoms and medical history. A physical exam will be done. The doctor will ask specific questions about:
The diagnosis will be made based on what the doctor finds during the exam. To determine a cause your doctor may need to run several tests:
Images of internal organs may also help to determine a cause. Images may be taken with:
Electrical activity of the heart and brain can be tested with electrocardiogram (EKG) and electroencephalogram (EEG).

Treatment

Delirium is first treated by identifying and treating the underlying cause. Then, symptoms are treated through medication, psychological management, and environmental and supportive interventions.
Treatments may include:

Medication

Drugs used to treat symptoms of delirium include:
  • High-potency antipsychotic medications
  • Benzodiazepines—used to treat delirium caused by alcohol withdrawal
  • Cholinergic medications—used to treat delirium caused by anticholinergic medications, which are used to treat stomach cramps and spasms in the intestines and bladder, among other conditions
  • Vitamins—given if the delirium is caused by low levels of vitamins
If you are taking medication that is worsening your confusion, you may be asked to stop these.

Psychological Management

Psychological therapy may help you:
  • Feel safer and more comfortable
  • Improve the ability to function
  • Calm down and feel less anxious

Environmental and Supportive Interventions

This type of treatment can be done by doctors, nurses, or caretakers. It can help you readjust to your surroundings and reduce anxiety. Examples of this intervention include:
  • Placing a clock and calendar in your room.
  • Darkening the room at night and providing natural light during the daytime hours.
  • Maintaining a quiet, noise-free room.
  • Using earplugs and/or eye shades during sleep to help reduce night noise.
  • Reminding you often of the day and time, where you are, and why you are there.
  • Placing familiar objects around you, such as family photographs or objects from home.

Prevention

A number of steps have been shown to help prevent delirium in hospitalized patients at risk for delirium. These steps include:
Delirium is difficult to prevent because it has so many causes and it can come on suddenly.

RESOURCES

American Psychiatric Association http://www.psychiatry.org

National Institute of Mental Health http://www.nimh.nih.gov

CANADIAN RESOURCES

Canadian Psychiatric Association http://www.cpa-apc.org

Canadian Psychological Association http://www.cpa.ca

References

Delirium in hospitalized patients. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated September 15, 2014. Accessed September 17, 2014.

Gleason O. Delirium. Am Fam Physician. 2003;67(5):1027-1034.

4/29/2016 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed: Litton E, Carnegie V, Elliott R, Webb SA. The efficacy of earplugs as a sleep hygiene strategy for reducing delirium in the ICU: a systematic review and meta-analysis. Crit Care Med. 2016;44(5):992-999.

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