General overview
Any neurological change in a person needs to be evaluated thoroughly in order to exclude any serious problems. The issues that need to be excluded all include the following:
- The use of drugs, substances and medications such as opioids, steroids or alcohol and even substance withdrawal.
- Infections, especially those affecting the central nervous system but also urinary and respiratory infections need to be excluded.
- Metabolic causes would include issues such as dehydration (leading to electrolyte imbalances), anaemia, malnutrirtion, endocrine disorders such as hyperthyroidism and hypercalcaemia and hypoglycaemia.
- Trauma to the head.
- Hypoxia which is a lack of oxygen to the brain. This can be caused by a stroke and even a heart attack.
- Psychiatric issues such as increased stressors can cause a patient to become delirious. Physical events such as pain, terminal illnesses and being restrained are also possible causes.
Signs and symptoms
The signs and symptoms of delirium can occur over a few hours to a few days, depending on the cause, and tend to fluctuate during the day and get worse at night.
The signs and symptoms of delirium are classified as follows:
Reduced awareness of one's environment
- Patients don't stay focused on a topic or switch between them.
- They are easily distracted by non-important aspects.
- They get stuck on an idea rather than giving an adequate response to a conversation.
- There's little response to their environment and they seem withdrawn.
Cognitive impairment
- Patients are disorientated to place, person and time.
- Poor memory recall, especially to recent events.
- Rambling speech with difficulty in recalling words or having difficulty with speaking.
- There's trouble in understanding speech as well as having difficulty in reading or writing.
Emotional issues and disturbances
- Anger or being irritated.
- Euphoria.
- Fear or anxiety.
- Paranoia.
- Apathy
- Mood shifts which occur quickly and are unpredictable.
- Personality changes.
Changes in behaviour
- Restlessness, agitation or being combative.
- Slowed down movements.
- Lethargy.
- Abnormal sleeping patterns.
- Hallucinations.
- Making moaning or other abnormal noises.
- Sleep-wake cycle is reversed.
- Becoming quiet and withdrawn.
Diagnosis
In order to determine the cause of the delirium, the above-mentioned issues are excluded by performing the following investigations:
- A mental status assessment is done to assess the patient's mental state as well as perception and memory recall.
- A physical and neurological exam is done to exclude any visible health issues.
- Blood and urine tests are done to exclude infections and electrolyte issues. Brain imaging tests are also done to exclude any intracranial problems.
Management
The best way to help prevent a recurrence is by trying to avoid the risk factors which may trigger a delirium episode. Therefore, good sleeping habits, the promotion of a calm environment and keeping the patient well-orientated are very important aspects which will help to improve the patient's health and help prevent possible recurrences.