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General overview

Abnormal behaviours or thinking processes by individuals which are random and transient in nature are difficult issues to try and find the cause of. The medical term for this issue is called delirium.

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  • There's little response to their environment and they seem withdrawn.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

They way in which delirium is managed will always depend on the cause of the problem. Medications may need to be reviewed or infections/endocrine abnormalities treated and electrolyte disturbances reversed.

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.

 

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