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Mental Health Tips > Delirium

Delirium
(Special thanks to Dr. Mimi Wong of Institute of Mental Health, Castle Peak Hospital, for authoring this article)

Delirium is a medical emergency. The patients will become confused within a short period of time due to an underlying medical, surgical or medication-related condition. It is important that the patient is taken to the hospital for proper assessment and treatment as early as possible as it can be life threatening.

 
1. What is delirium?
2. What are the features of delirium?
3. What are the causes of delirium?
4. How is delirium treated?
5. How can I help someone with delirium?



1. What is delirium?

Delirium is a state of mental confusion which happens when the brain function is impaired by an illness in other parts of body. It is also known as an 'acute confusional state'. It is common in the elderly.

Delirium is a medical emergency. A sudden onset of mental confusion usually indicates an acute medical illness which warrants immediate medical attention. A delay in treatment might lead to harmful consequences or even death.

Elderly people are particularly vulnerable to have delirium as it is common for them to have multiple medical illnesses and they may have age-associated cognitive deterioration. Even a mild medical illness may reduce the supply of oxygen and nutrient to the brain and significantly affect its functioning.

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2. What are the features of delirium?

The features of delirium include:

  • Be unsure about where you are or what you are doing there.
  • Be unable to follow a conversation or to speak clearly.
  • Be less aware of what is going on around you.
  • Hear noises or voices when there is nothing or no one to cause them.
  • See people or things which aren’t there.
  • Sleep during the day but wake up at night
  • Be very agitated or restless, unable to sit still and wandering about.
  • Have moods that change quickly. You can be frightened, anxious, depressed or irritable.
These changes may happen suddenly and they make the patients very different from their normal selves. It is also possible that the condition of the patients changes throughout the day.

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3. What are the causes of delirium?

The most common causes of delirium are:

  • Infection, e.g. chest infection, urinary tract infection, a generalized infection.
  • Endocrine problems: Diabetes Mellitus, thyroid problems
  • Problems related to the central nervous system: Stroke
  • Hypoxic condition: Heart failures, chest infection, chronic obstructive airway disease
  • Liver or kidney problems
  • Constipation
  • Chemical problems in the body, such as dehydration or low salt levels
  • Side effects of medications like sleeping pills or antihypertensives
  • Suddenly stopping drugs or alcohol

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4. How is delirium treated?

If someone suddenly becomes confused, they need to see a doctor urgently. The person with delirium may be too confused to describe what has happened to them, so it's important that the doctor can talk to someone who knows the patient well.

To treat delirium, you need to treat the cause. For example, an infection may be treated with antibiotics.

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5. How can I help someone with delirium?

Besides the use of medications, proper care and handling technique is also important to reduce any behavioural problem a patient with delirium may have. Close observation and monitoring is important to the patient.

  • Nurse them in a quiet environment and feed them with proper supplement when they are awake and cooperative to prevent further dehydration.
  • Ensure the surroundings are safe and comfortable with enough lighting. Store up dangerous equipments to prevent accidents.
  • Try not to agree with any unusual or incorrect ideas, but tactfully disagree or change the subject.
  • Remind them of the time and date and try to make sure that someone they know well is with them.

Websites with relevant information / Reference

The National Institute for Health and Clinical Excellence
National Institute for Health and Clinical Excellence guidelines

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