Delirium

DELIRIUM

• Most commona organic mental disorder.
• Most commonly in elderly population.

Etiology:

• Patients with hip fractures, open heart surgeries, severe burns, pneumonla, postoperatlve patlentsa & critically ill patients – High prevalence.
  • History of medical disorder followed by sudden development of disturbances of consciousness, cognition & psychiatric symptoms (hallucinations & delusions) – Strongly suggestive of delirium.
• Drug usage – Anmticholinergics, Withdrawal of psychoactive substances (such as alcohol and sedatives/hypnotics.
• In older patients wearing eye patches after cataract surgery (due to sensory deprivation) – Black-patch delirium.
• Neurotransmitter involved – Acetylcholine.
• Neuroanatomical area involved – Reticular formation.

Features:

• Characterized by an acute onset of symptoms & fluctuating course.

Symptoms:

• Disturbances of consciousness (ranging from somnolence to coma)
  • ‘Clouding of consciousness’/altered sensorium’.
• Impairment of attention
• Disorientation to time, place and person
• Memory disturbances (impairment of immediate & recent memory with relatively intact remote memory)
• Perceptual disturbances – Illusions & hallucinations (most commonly visual) & transient delusions.
• Hyperactivity or hypoactivity, agitation.
• Autonomic disturbances.
• Disturbances of sleep-wake cycle (insomnia or reversal of sleep-wake cycle)
• Sundowning – Refers to diurnal variation of symptoms with worsening of symptoms in the evening (i.e. with downing of sun).
• Floccillations/carphologia): Aimless picking behavior (appeats to be picking at his clothes/bed.
• Occupational delirium: Patient behaves still being on job, despite being in hospital (e.g. a tailor may ask for clothes and scissors, while on hospital).

Diagnosis:

• Clinically made.
• Important pointers – Sudden onset & fluctuations in symptoms.
• For measure of cognitive impairment – mini mental status examination (MMSE) & mental status examination (MSE).
• Generalized slowing on EEG.

Treatment:

• Treating underlying cause.
• Antipsychotics – Management of delusions, hallucinations & agitation.
• Benzodiazepines – For insomnia & DOC in alcohol withdrawal delirium (delirium tremens).

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