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Delirium is a change in mental status. Delirium is marked by extreme, fluctuating changes, including:
- Changes in perception and sensation
Difficulties with ability to:
- Sustain and shift attention
- Think and reason rationally
- Function normally
- Communicate clearly
Hundreds of underlying causes can result in delirium. Some of the most common causes include:
- Serious medical condition such as a brain tumor, cancer, kidney failure, heart attack, stroke, seizures, and low or high blood sugar levels
- Serious infections, such as meningitis, pneumonia, and urinary tract infections
- Toxic effects of medications
- Injury such as severe head injury, broken bone, and severe pain
- Alcohol or drug abuse
- Withdrawal from alcohol or drug abuse
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Factors that may increase your risk of developing delirium include:
- Terminal illness, especially just before death
- Serious illness, such as AIDS
- Increased age
- Severe sleep deprivation
- Severe burn
- Central nervous system problems such as stroke, seizures, tumors, and dementia
- Visual or hearing impairment
- Severe constipation
- Memory impairment
- Deficiency in certain vitamins
Symptoms usually come on quickly and can last for days, weeks, or longer. They also vary in severity depending on the cause. Symptoms are often worse at night and may include:
- Inability to pay attention
- Memory problems
- Language disturbances
Disorientation, especially about:
- Time of day
- Where one is
- Who one is
Severe symptoms include:
- Misinterpretations—for example, thinking a doctor who is trying to help you is trying to hurt you
- Illusions—for example, thinking someone is someone else
- Hallucinations—seeing, hearing, or feeling things that are not there
- Emotional disturbances—for example, suddenly becoming angry, fearful, or withdrawn for no apparent reason
You will be asked about your symptoms and medical history. A physical exam will be done. The doctor will ask specific questions about:
- Present injury or illness
- Use of medications or illicit drugs
- Time when mental state changed
- How and how fast the mental state changed
The diagnosis will be made based on what the doctor finds during the exam. To determine a cause your doctor may need to run several tests:
- Blood tests
- Urine tests
- Lumbar puncture
- Kidney and liver function tests
- Thyroid function tests
Images of internal organs may also help to determine a cause. Images may be taken with:
Delirium is first treated by identifying and treating the underlying cause. Then, symptoms are treated through medication, psychological management, and environmental and supportive interventions.
Treatments may include:
Drugs used to treat symptoms of delirium include:
- High-potency antipsychotic medications
- Benzodiazepines—used to treat delirium caused by alcohol withdrawal
- Cholinergic medications—used to treat delirium caused by anticholinergic medications, which are used to treat stomach cramps and spasms in the intestines and bladder, among other conditions
- Vitamins—given if the delirium is caused by low levels of vitamins
If you are taking medication that is worsening your confusion, you may be asked to stop these.
Psychological therapy may help you:
- Feel safer and more comfortable
- Improve the ability to function
- Calm down and feel less anxious
Environmental and Supportive Interventions
This type of treatment can be done by doctors, nurses, or caretakers. It can help you readjust to your surroundings and reduce anxiety. Examples of this intervention include:
- Placing a clock and calendar in your room.
- Darkening the room at night and providing natural light during the daytime hours.
- Maintaining a quiet, noise-free room.
- Using earplugs and/or eye shades during sleep to help reduce night noise.
- Reminding you often of the day and time, where you are, and why you are there.
- Placing familiar objects around you, such as family photographs or objects from home.
A number of steps have been shown to help prevent delirium in hospitalized patients at risk for delirium. These steps include:
- Using memory orientation aids
- Listening to relaxation tapes
- Doing light exercise—when possible and if advised by your doctor
- Using vision and hearing aids when necessary
- Drinking plenty of fluids to prevent dehydration
Delirium is difficult to prevent because it has so many causes and it can come on suddenly.
American Psychiatric Association
National Institute of Mental Health
Canadian Psychiatric Association
Canadian Psychological Association
Delirium in hospitalized patients. EBSCO DynaMed Plus website. Available at: http://www.dynamed.com/topics/dmp~AN~T116623/Delirium-in-hospitalized-patients. Updated August 30, 2016. Accessed September 23, 2016.
Gleason O. Delirium. Am Fam Physician. 2003;67(5):1027-1034.
4/29/2016 DynaMed Plus Systematic Literature Surveillance http://www.dynamed.com/topics/dmp~AN~T116623/Delirium-in-hospitalized-patients: Litton E, Carnegie V, Elliott R, Webb SA. The efficacy of earplugs as a sleep hygiene strategy for reducing delirium in the ICU: a systematic review and meta-analysis. Crit Care Med. 2016;44(5):992-999.
- Reviewer: Rimas Lukas, MD
- Review Date: 09/2016
- Update Date: 04/29/2016