Delirium

by Carol Gomes


Delirium is one type of an organic mental disorder. According to DSM-IV, delirium is a disturbance of consciousness manifested by clarity of awareness of the environment. Delirium is characterized by impaired consciousness and cognition during the course of several hours or days. Delirium is one of earliest recognized mental disorders. People with delirium are confused, disoriented and out of touch with their surroundings. Disorientation is regarding time (such as thinking of morning during night time) and place. They cannot focus or sustain their attention on the simplest task. There are marked impairments in memory and language. Also speech and perceptual abilities are impaired. Speech is almost rambling and coherent whereas perceptual disturbance include misinterpretations, illusions and hallucinations. Language impairment such as dysnomia (impaired ability to name objects) or dysgraphia (impaired ability to write).Individuals with delirium are restless and hyperactive. Emotional disturbances are also exhibited such as anxiety,irritability,anger,euphoria and depression.

All these disturbances occur over a short period of time and fluctuates over the day. Delirium is most prevalent among older adults, people undergoing medical procedures, cancer patients and people with AIDS. Diagnostic Statistical Manual -IV(DSM) for delirium includes disturbance of consciousness and a change in cognitive abilities such as memory and language skills. Some of the subtypes of delirium are : Substance induced, delirium due to multiple etiologies ,delirium not otherwise specified and due to general medical condition.

Delirium is mostly caused by improper use of medication among older adults. Factors other than medical condition can too trigger delirium. Laboratory findings such as EEG shows disturbance in brain activity. The brain waves either predicts slowing of an activity or fast activity. Age itself is an important factor . Older adults are more susceptible to develop delirium as a result of mild infection ,head injury or medication changes. Sleep deprivation, immobility and excessive stress can also cause delirium.

Delirium caused by withdrawal from alcohol or other drugs are treated with calming and sleep induced medication. People with acute delirium are treated with antipsychotic drugs. Psychosocial intervention help in dealing with the anxiety, agitation and hallucination of delirium. But as mentioned above ,people with delirium are unable to sustain attention or concentration and cognition ,Psychotherapy is not of much help to them. But self-help skills help the patient to be independent and active.

Preventive efforts also help in assisting people who are susceptible to delirium. Proper medical care and therapeutic drug play a significant role in preventing delirium.


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