Treatment of Delirium in Adults
Delirium in adults is a cognitive disorder that mostly occurs in the elderly but can develop in people of any age, and is defined as sudden confusion. This condition generally begins rapidly and can cause brief episodes of inattentiveness, mental confusion, and loss of awareness of time and place.
Delirium may generally arise due to factors such as severe and long-standing physical illnesses, infections, sodium deficiency, electrolyte imbalances, neurological problems, hospitalization, undergoing surgery, or alcohol dependence. People in this condition may lose their sense of reality, experience memory problems, have difficulty with attention and concentration, or see hallucinations.
Treatment of delirium is aimed primarily at identifying the underlying cause and improving this condition. Delirium in adults can be treated through multidisciplinary approaches in the physical, neurological, and psychological domains.
What Does Delirium Mean?
Delirium refers to sudden-onset changes that affect mental state. These changes may include forgetfulness, confusion, speech and expression problems, and being unable to realize where one is. The symptoms that appear generally begin within a short period, such as a few hours or days, may worsen over time, and become especially noticeable at night. Delirium does not cause the same symptoms in everyone and may appear in different forms from person to person. According to its different characteristics, delirium can be examined in the following types:
Hyperactive delirium: Hyperactive delirium can cause an excessively aroused, agitated, and excited state in the person. The person may have rapidly changing thoughts, speech, and movements. This condition is generally seen due to side effects of medications used for a long time, or stimulant substances such as alcohol or substance withdrawal.
Hypoactive delirium: Unlike hyperactive delirium, hypoactive delirium can cause lethargy, weakness, and a passive state in people. Sluggishness, slow speech, social withdrawal, constant sleepiness, mental cloudiness, and reduced responsiveness may be seen. This type of delirium may develop due to many different causes, such as infections, medications, or neurological factors.
Mixed delirium: This type is a combination of both hyperactive and hypoactive delirium. Individuals may at times be sluggish, withdrawn, and drowsy, while at other times they may show symptoms such as moving quickly, thinking, talking excessively, being excited, and not wanting to sleep.
What Are the Symptoms of Delirium in Adults?
Symptoms of delirium in adults may vary from person to person and usually fluctuate during the day. Symptoms may include decreased environmental awareness, weakened thinking ability, and behavioral and emotional changes. In general, symptoms of delirium in adults may include:
Inability to focus on a topic and changing subjects
Not answering questions asked and diverting from the topic
Easily distracted attention
Moving very little or being overly active
Forgetting the recent past and weak memory
Being unable to realize where one is and what the time is
Inconsistent and meaningless speech or not speaking at all
Problems with reading and writing
Fear of others, withdrawal, and feeling anxious
Being restless, quarrelsome, or feeling excessively happy
Calling out, making noises, and moaning
Changes in day-night perception and sleep problems
Depression and various mood changes
Delirium symptoms may vary from person to person, and symptoms may increase in the evening or at night. This condition generally begins quickly and reaches its peak within a short time. Since delirium is a sign of an underlying health problem, if the mentioned symptoms are noticed, it is necessary to consult a healthcare professional.
What Are the Main Factors Causing Delirium?
Delirium is generally seen as a result of a combination of one or more causes, or in some cases no specific cause can be identified. This condition occurs when signals in the brain are not transmitted or are not fully processed. In general, some of the factors causing delirium are:
Use of certain medications and side effects of medications
Alcohol or drug use or withdrawal
Heart attack, liver and lung diseases, or diabetes
Stroke and epilepsy
Head trauma
Long-lasting severe diseases or serious diseases that may be considered life-threatening
Pneumonia, flu, COVID-19, or infectious diseases affecting the urinary tract
Exposure to toxic substances such as carbon monoxide and cyanide
Inadequate nutrition and severe fluid loss
Sleep problems such as sleeping too much or not sleeping at all
Surgical procedures requiring anesthesia
Long hospital stays
Chronic pain
These factors may be considered among the causes of delirium, but these specific factors may vary from person to person. To determine the causes of delirium and ensure appropriate treatment management, it is important to apply to a healthcare institution and obtain expert support.
How Is Delirium Diagnosed?
Delirium can be diagnosed by a healthcare professional based on evaluation of symptoms. Some steps to be followed for diagnosing delirium are as follows:
Taking medical history: The doctor may gather information about the symptoms by asking what has changed recently. Whether there is any infection, the start of a new medication, chest pain, or an injury is questioned. Whether the person uses alcohol or drugs is also taken into account.
Mental health examination: The doctor may perform a mental health assessment by talking with the person or conducting some tests to measure their awareness and attention. For a more reliable assessment, family members or caregivers may also be consulted.
Physical examination: Physical examination can detect whether there are various health problems or signs of disease. During the examination, vision, hearing, balance, coordination, and reflexes are also assessed.
Laboratory and imaging tests: These tests can be used to detect metabolic disorders or other health problems that may cause delirium. Blood and urine analyses can evaluate electrolyte levels and liver and kidney function, while imaging tests can detect various neurological disorders.
Diagnosis of delirium can be made based on indicators such as how quickly the symptoms began, whether they fluctuate, the presence of impairments in physical and psychological functions, and changes in the perception of reality. After the underlying cause of delirium is identified, appropriate treatment can be started.
How Is It Treated?
The main goal of treating delirium in adults is to eliminate the underlying cause, prevent its triggering, and alleviate symptoms. Treatment generally requires a multidisciplinary approach and includes cooperation among the doctor managing the patient's medical condition, psychologists, psychiatrists, nurses, and other healthcare professionals. Some of the methods applied in delirium treatment are:
Treatment of the underlying cause: If there is a physical illness causing delirium, this condition is treated first. For example, if there is an infection, antibiotics are given, or if there is a drug side effect, medications may be changed.
Supportive treatment: In delirium treatment, meeting the person's basic needs and supporting body functions is important. For this, adequate fluid intake and nutrition, pain control, and ensuring hygiene are necessary.
Environmental adjustments: Reducing environmental factors that may trigger delirium can aid treatment. These may include using lighting similar to daylight, preventing loud noise, ensuring sleep hygiene and routine, and displaying hours and calendars in a visible manner.
Medication treatment: In some people, medication may be required to manage symptoms. For example, antipsychotic drugs may be given for agitation and anxiety, and sedatives for sleep problems. Since uncontrolled use of such medications may trigger delirium, dose adjustment and the decision to use them can only be made by a doctor.
Delirium treatment may vary depending on the cause and the person's condition. However, early diagnosis and treatment are important in all cases. Therefore, if you are caring for someone showing delirium symptoms, you should consult a healthcare professional.
Frequently Asked Questions
Questions and answers that people with delirium and their relatives are curious about are as follows: Delirium is an acute condition that temporarily affects mental functions and can be treated. Personality disorder, on the other hand, is a chronic, long-lasting condition. For this reason, it cannot be said that delirium causes a personality disorder. Delirium does not directly damage any organ in the body, but if the condition causing it is not treated, some organs may be affected. Delirium left untreated for a long time may lead to damage in brain functions, the digestive system, lungs, or kidneys. Medications used in delirium treatment, in some advanced cases, aim to bring symptoms under control. Antipsychotics and sedatives may be used for anxiety, agitation, and sleep problems. Whether hospitalization is necessary depends on the severity of delirium, the underlying causes, and the patient's general health condition. In severe cases, hospitalization may be required for more effective treatment of underlying medical problems. Also, if there are concerns about the patient's safety, fluid intake, or nutrition, hospitalization may be necessary for supervision and care. Persons diagnosed with delirium may pose a risk of harm to themselves or others. This may be caused by loss of awareness, memory problems, or alcohol or substance withdrawal. Delirium in adults is a sign of an underlying health problem, and if left untreated, both the medical condition and the delirium may progress. If you think you or a close relative may have delirium, you can apply to our team of expert physicians at Hisar Hospital Intercontinental.
