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Delirium

Delirium is an acutely disturbed state of mind characterized by restlessness, illusions, and incoherence, occurring in intoxication, fever, and other disorders. It is a state of mental confusion which develops quickly and usually fluctuates in intensity.

Causes

Delirium occurs when the normal sending and receiving of signals in the brains becomes impaired. This impairment is most likely caused by a combination of factors that make the brain vulnerable and trigger a malfunction in brain activity .Any condition that results in a hospital stay, especially in intensive care, increases the risk of delirium.

Common causes include dehydration and infection. Examples of other conditions that increase the risk of delirium include:-

  • Previous delirium episodes
  • Visual and hearing impairment
  • Dementia
  • Old age
  • Fever and acute infection
  • Poor nutrition
  • Dehydration
  • Severe, chronic or terminal illness
  • Alcohol or drug abuse or withdrawal
  • Multiple medical problems or procedures
  • Treatment with medical drugs
  • A number of medications or combinations of medications can trigger delirium, including some types of:
    • Pain medication
    • Sleep medication
    • Allergy medication (antihistamines)
    • Medications for mood disorders, such as anxiety and depression
    • Parkinson’s disease medications
    • Drugs for treating spasms or convulsions

Symptoms

The signs and symptoms of delirium appear over a short period of time from a few hours to a few days. They often fluctuate throughout the day so a person may have periods of no reduced awareness of the environment this may result in-

  • An inability to stay focused on a topic.
  • Wandering attention
  • Getting stuck on an idea rather than responding to questions or conversation
  • Being easily disturbed by unimportant things
  • Being withdrawn with little or no activity or little response to the environment poor thinking skills

This may appear as:-

  • Poor memory particularly of recent events
  • Disorientation or not knowing where one is, who one is or what of day it is
  • Difficulty speaking or recalling words
  • Rambling or nonsense speech
  • Difficulty understanding speech
  • Difficulty reading or writing

Behavior changes

  • Seeing things that don’t exist (hallucination)
  • Disturbed sleep habits
  • Restlessness, agitation, irritability or combating behavior
  • Extreme emotions, such as fear,anxiety,anger or depression

Delirium and Dementia

Other medical conditions can result in symptoms associated with delirium. Dementia and delirium may be particularly difficult to distinguish and a person may have both. In fact, frequently delirium occurs in people with dementia.

When to see a doctor?

If a relative, friend shows any signs or symptoms of delirium, consult a doctor. If the person has dementia, be aware of relatively sudden changes in overall awareness and engagement, which may signal delirium. Your input about the person’s symptoms, as well as his or her typical thinking and everyday abilities, will be important for a diagnosis.

Older people recovering in the hospital or living in a long-term care facility are particularly at risk of delirium because symptoms can fluctuate and some symptoms are “quite”- such as social withdrawal or poor responsiveness.

Complications

Delirium may last only a few hours or as long as several weeks or months. If factors contributing to delirium are addressed, the recovery times are often shorter. The degree of recovery depends to some extent on the health and mental status before the onset of delirium, for example, may experience a significant overall decline in memory and thinking skills. People in better health are more likely to recover fully. People with other serious, chronic or terminal illness may not regain levels of thinking skills or function that they had before the onset of delirium. Delirium in seriously ill people is also more likely to lead to

  • General decline in health
  • Poor recovery from surgery
  • Need for institutional care
  • Increased risk of death

Test and Diagnosis

A doctor will diagnose delirium based on the person’s medical history, tests to assess mental status and the identification of possible contributing factors. An examination may include the following

  • Mental Status assessment
  • Physical and neurological exam

Treatment

The first goal of treatment for delirium is to address any underlying causes or triggers by stopping the use of a particular medication. Treatment then focuses on creating the best environment for healing the body and calming the brain.

Supportive care

A number of simple, non-drug approaches may be of some help:

  • Clocks and calendars to help a person stay oriented
  • A calm, comfortable environment that includes familiar objects from home
  • Involvement with family members
  • Avoidance of change in surroundings and caregivers
  • Uninterrupted periods of sleep at night, with low levels of noise and minimal light
  • Open blinds during day to promote daytime alertness and a regular sleep-wake cycle.
  • Adequate nutrition and fluid.
  • Use of adequate light, music, massage and relaxation techniques to ease agitation.

Prevent complicating problems

  • Giving the person his or her medication on regular basis
  • Encourage regular exercise and activity.
  • Use simple and regular communication about people, current place and time.

Homeopathic medicines have been found useful in management of cases of delirium. Some of the commonly used remedies are Agaricus, Cannabis indica, Nux vomica, Bellodona, Hyocyamus, Stramonium, Cimicifuga, Thuja,  etc. These medicines should only be taken under guidance of a qualified Homoeopathic physician.



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