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| Delirium, Causes, Diagnosis, Treatment, Prevention, Complications |
Delirium is a condition when a person experiences severe confusion and decreased awareness of the surrounding environment. This condition is most often experienced by someone over the age of 65 and suffering from another mental disorder.
Delirium occurs when the brain is suddenly disturbed due to certain mental or physical illnesses. A person with delirium may appear delirious or daydreaming like a person with dementia. The difference is, delirium is temporary and usually goes away completely.
Please note, delirium can appear in people with COVID-19, especially the elderly. This can occur due to the influence of a cytokine storm or a lack of oxygen to the brain. Therefore, delirium needs to be taken seriously so that the exact cause can be identified and treated.
Causes of Delirium
Delirium occurs when the brain's system of sending and receiving signals is disrupted. The disorder can be caused by a combination of drug poisoning and medical conditions that reduce oxygen supply to the brain.
Some of the factors that can cause delirium are:
- Overdose of medications, such as pain relievers, sleeping pills, allergy medications (antihistamines), corticosteroids, anticonvulsants, Parkinson's disease medications, and medications for mood disorders
- Alcohol poisoning or sudden cessation of alcohol consumption
- Overreaction to infections, such as pneumonia, urinary tract infections, typhoid fever, sepsis, or COVID-19, especially in the elderly
- Poisoning of a substance, such as cyanide or carbon monoxide
- Surgery or other medical procedures involving anesthesia
- Severe illness, such as kidney failure, electrolyte imbalance, hypothyroidism, or stroke
- High fever caused by acute infection in children
- Malnutrition (lack of nutrients) or dehydration (lack of fluids)
- Lack of sleep
- Heavy stress
Delirium risk factors
Delirium can happen to anyone. However, there are several factors that can increase a person's risk of developing delirium, namely:
- Currently undergoing hospitalization, especially if undergoing treatment in the ICU or surgery under general anesthesia
- Over 65 years old
- Suffering from a disease caused by a disorder in the brain, such as dementia, stroke, or Parkinson's disease
- Suffering from a disease that causes severe pain, such as cancer
- Have you had delirium before?
- Have vision or hearing problems
- Suffering from several diseases
Symptoms of Delirium
Delirium is characterized by changes in mental state that can last from a few hours to several days. Changes in mental conditions can disappear and appear throughout the day, but more often appear when the atmosphere is dark or does not feel familiar to the sufferer.
Symptoms that can occur in people with delirium are:
Reduced awareness of the surrounding environment
This condition is characterized by:
- Difficulty focusing on a topic or suddenly changing the subject
- Easily distracted by unimportant things
- Likes to daydream so he doesn't react to things happening around him
Poor thinking skills (cognitive impairment)
Complaints arising from this condition include:
- Memory decline, especially on things that just happened
- Not realizing who he is or where he is
- Difficulty finding words to speak
- Slurred or incomprehensible speech
- Difficulty understanding speech, reading, and writing.
Emotional disturbance
Patients with delirium with this condition may experience complaints, such as:
- Restless or anxious
- Afraid
- Depression
- Easily offended
- Apathetic
- Looks very happy or happy
- Sudden mood changes
- Personality changes
Changes in behavior
Symptoms in people with delirium with this condition include:
- hallucination
- Aggressive in behavior
- Yelling, moaning, or yelling at those around you
- Quiet and shut up
- Slow movement
- Sleep disturbance
Meanwhile, based on the symptoms experienced by the patient, delirium can be divided into several types, namely:
1. Hyperactive delirium
Hyperactive delirium is the most easily recognized type of delirium. This type is characterized by symptoms of anxiety, mood changes, and active behavior (yelling or calling), hallucinations, and difficulty concentrating.
2. Hypoactive delirium
Hypoactive delirium is a common type of delirium. This type of delirium causes the sufferer to be silent, lethargic, sleepy, and appear dazed
3. Mixed delirium
This type of delirium often shows a change in symptoms from hyperactive delirium to hypoactive delirium, or vice versa
4. Delirium tremens
This type of delirium occurs in someone who has stopped drinking alcohol. Symptoms that arise in this type of delirium are shaking in the legs and hands, chest pain, confusion, and hallucinations
When to go to the doctor
Immediately see a doctor if you or those around you experience symptoms of delirium. If not treated properly, delirium can worsen and put the patient at risk.
Diagnosis of Delirium
To diagnose delirium, the doctor will ask questions about the symptoms experienced, medical history, and medications that the patient is currently taking.
Delirium patients may be difficult to cooperate with and question. Therefore, information from family or people closest to the patient is needed so that the diagnosis becomes accurate.
Furthermore, the doctor may perform several tests to diagnose delirium, namely:
Physical and neurological examination
The doctor will perform a physical examination to check for possible disorders or diseases that can cause delirium, as well as to determine the patient's level of consciousness. If possible, the doctor will also perform a neurological examination by checking the patient's condition of vision, balance, coordination, and reflexes.
Mental condition check
In this examination, the doctor will assess the patient's level of awareness, attention, and thinking by asking specific questions.
Supporting investigation
The doctor may suggest several other tests to determine if there is a disturbance in the body, such as:
- Blood tests, to detect infection or electrolyte disturbances
- Urine test, to see kidney function or a possible urinary tract infection
- Liver function tests, to detect the occurrence of liver failure that can trigger encephalopathy
- Thyroid function tests, to detect hypothyroidism
- Electroencephalography, to check the electrical activity of the brain
In addition to the above examinations, doctors can perform chest X-rays and head scans with CT or MRI scans. If needed, a cerebrospinal fluid analysis will be performed to confirm the diagnosis of delirium.
Delirium Treatment
The main goals of treatment for delirium are to prevent harm from loss of consciousness and treat the causes of delirium. Treatment methods include:
Drugs
Medications may be given to relieve symptoms of anxiety, fear, or hallucinations. Some drugs that can be given based on the symptoms are:
- Antidepressants, to treat depression
- Tranquilizers or sedatives, to treat anxiety disorders
- Antipsychotics, to treat symptoms of psychosis, such as hallucinations
- Thiamine or vitamin B1, to prevent severe confusion
Doctors can also give medication to treat the underlying disease. For example, the doctor will give an inhaler to a patient who has delirium due to asthma.
Supportive therapy
In addition to drugs, supportive therapy is also needed to prevent complications. Some forms of supportive therapy that can be given are:
- Keep the respiratory tract from being closed
- Provide fluids and nutrients that the patient's body needs
- Helping the patient to move or do activities
- Handling the pain experienced by the patient
Hyperactive delirium patients may make noise or wet the bed several times. However, it is not recommended to tie the patient or place a urinary catheter in the patient. This will only make him more anxious and make his symptoms worse.
Family or people closest to the patient should also continue to interact with the patient and make the surrounding environment comfortable for the patient. Some of the efforts that can be made to help control the patient's symptoms are:
- Speak to the patient in short and simple sentences
- Remind the patient of the time, date and situation that occurred at that time
- Remain calm when the patient is talking and do not argue with him even if what is said is not clear or makes no sense
- Help the patient when eating and drinking
- Bring objects at home that the patient recognizes
- Turn on the light at night so that the patient can see the condition around him when he wakes up
Delirium Complications
Delirium can cause complications, especially in patients who have serious illnesses. Some of the complications are:
- Drastic decline in the ability to remember and think
- Decrease in general health condition
- Healing that doesn't go well after surgery
- Increased risk of death
Delirium Prevention
Delirium is difficult to prevent. However, the risk of developing delirium can be reduced. Some of the efforts that can be made to reduce the risk factors for delirium are:
- Live a healthy diet
- Limiting or avoiding alcohol consumption
- Take medicines as recommended by the doctor
- Doing exercise regularly
For people who are at higher risk for developing delirium, for example people with dementia or patients who are seriously ill, prevention of delirium that can be done is:
- Avoid significant mood swings or creating noise
- Adopt a healthy and regular sleep schedule
- Provide a bedroom with good lighting
- Creating a calm and stable atmosphere
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