Delirium
Delirium is a state of mental confusion which develops quickly and usually fluctuates in intensity. A state in which the thoughts, expressions, and actions are wild, irregular, and incoherent, mental aberration, a roving or wandering of the mind- usually dependent on a fever or some other disease, and so distinguished from mania, or madness.
Symptoms:
The signs and symptoms of delirium appear over a short period of time, from a few hours to a few days. They often fluctuate throughout the day so a person may have periods of no reduced awareness of the environment this may result in
- An inability to stay focused on a topic or to change topics
- Wandering attention
- Getting stuck on an idea rather than responding to questions or conversation
- Being easily disturbed by unimportant things
- Being withdrawn, with little or no activity or little response to the environment poor thinking skills
This may appear as:
- Poor memory, particularly of recent events
- Disorientation, or not knowing where one is, who one is or what of day it is
-Difficulty speaking or recalling words
- Rambling or nonsense speech
- Difficulty understanding speech
- Difficulty reading or writing
Behavior changes:
- Seeing things that don't exist(hallucinations)
- Disturbed sleep habits
- Restlessness, agitation, irritability or combative behavior
- Extreme emotions, such as fear, anxiety, anger or depression
Delirium and dementia:
Other medical condition can result in symptoms associated with delirium. Dementia and delirium may be particularly difficult to distinguish, and a person may have both. In fact, frequently delirium occurs in people with dementia.
Dementia is the progressive decline in memory and other thinking skills due to the gradual dysfunction and loss of brain cells. The most common cause of dementia is Alzheimer's disease.
Some differences between the symptoms of delirium and dementia include:
- Onset: The onset of delirium occurs within a short time. While dementia usually begins with relatively minor symptoms that gradually worsen over time.
- Attention: The inability to stay focused or maintain attention is significantly impaired with delirium. A person in the early stages of dementia remains generally alert.
- Fluctuation: The appearance of delirium symptoms can fluctuate significantly and often throughout the day. While people with dementia have better and worse times of day, their memory and thinking skills stay at a fairly constant level during the course of a day.
When to see a doctor???
If a relative, friend or someone in your care shows any signs or symptoms of delirium, see a doctor. If the person has dementia, be aware of relatively sudden changes in overall awareness and engagement. Which may signal delirium. Your input about the person's symptoms, as well as his or her typical thinking and everyday abilities, will be important for a diagnosis.
Older people recovering in the hospital or living in a long-term care facility are particularly at risk of delirium. Because symptoms can fluctuate and some symptoms are "quiet" -such as social withdrawal or poor responsiveness- delirium may be missed. If you notice signs and symptoms of delirium in a person in a hospital or nursing home, report your concerns to the nursing staff or doctor rather than assuming that those problems have been observed.
Causes:
Delirium occurs when the normal sending and receiving of signals in the brain becomes impaired. This impairment is most likely caused by a combination of factors that make the brain vulnerable and trigger a malfunction in brain activity. Any condition that results in a hospital stay, especially in intensive care, increases the risk of delirium.
Common causes include dehydration and infection, such as urinary tract infection. Pneumonia, and skin and abdominal infections. Examples of other conditions that increase the risk of delirium include.
- Previous delirium episodes
- Visual or hearing impairment
- Dementia
- Older age
- Fever and acute infection, particularly in children
- Poor nutrition
- Dehydration
- Severe, chronic or terminal illness
- Alcohol or drug abuse or withdrawal
- Multiple medical problems or procedures
- Treatment with multiple drugs.
A number of medications or combinations of medications can medications can trigger delirium, including some types of:
- Pain medications
- Sleep medication
- Allergy medications(antihistamines)
- Medications for mood disorders, such as anxiety and depression
- Parkinson's disease medications
- Drugs for treating spasms or convulsions
- Asthma medication
Delirium may have more than one causes, such as a medical condition and medication toxicity.
Complications:
Delirium may last only a few hours or as long as several weeks or months. If factors contributing to delirium are addressed, the recovery times are often shorter. The degree of recovery depends to some extent on the health and mental status before the onset of delirium, for example, may experience a significant overall decline in memory and thinking skills. People in better health are more likely to recover fully. People with other serious, chronic or terminal illness may not regain the levels of thinking skills or function that they had before the onset of delirium. Delirium in seriously ill people is also more likely to lead to:
- General decline in health
- Poor recovery from surgery
- Need for institutional care
- Increased risk of death
Tests and Diagnosis:
A doctor will diagnosis delirium based on the answer to questions about a person's medical history, tests to assess mental status and the identification of possible contributing factors.
An examination may include the following:
Mental status assessment:
A doctor starts by assessing awareness, attention, and thinking. This can be done informally through conversation, or more formally with tests or screening checklists that assess mental status, confusion, perception, and memory.
Physical and neurological exam:
The doctor will perform a physical exam, checking for signs of dehydration, infection, alcohol withdrawal and other problems. The physical exam- can also help detect underlying disease. Delirium may be the first or only sign of a serious condition, such as respiratory failure or heart failure. A neurological exam- checking vision, balance, coordination, and reflexes- can help determine a stroke or another neurological disease is causing delirium.
Other possible tests:
If the cause or trigger of delirium can't be determined from the medical history or exam the doctor may order blood, urine, and diagnostic tests. Brain imaging tests may be used when a diagnosis can't be made other available information.
Treatment:
The first goal of treatment for delirium is to address any underlying causes or triggers- by stopping the use of a particular medication, for example, or treating an infection. Treatment then focuses on creating the best environment for healing the body and calming the brain.
Supportive care:
Supportive care aims to prevent complications by protecting the airway, providing fluids and nutrition, assisting with movement, treating pain, addressing incontinence and keeping people with delirium oriented to their surroundings.
A number of simple, nondrug approaches may be of some help:
- Clocks and calendars to help a person stay oriented
- A calm, comfortable environment that includes familiar objects from home
- Involvement of family members
- Avoidance of change in surroundings and caregivers
- Uninterrupted periods of sleep at night, with low levels of noise and minimal light
- Open blinds during the day to promote daytime alertness and a regular sleep-wake cycle
- Adequate nutrition and fluid
- Use of adequate light, music, massage and relaxation techniques to ease agitation
- Opportunities to get out of bed, walk and perform self-care activities
- Provision of eyeglasses, hearing aids and other adaptive equipment as needed.
Medications:
Talk with the doctor about avoiding or minimizing the use pf drugs that may trigger delirium. However, certain drug treatment may calm a person who misinterprets the environment in a way that leads to severe paranoia, fear or hallucinations and when severe agitation or confusion.
- Prevents the performance of a necessary medical exam or treatment
- Doesn't lessen with nondrug treatment
To promote good sleep habits:
- Keep inside lighting appropriate for the time of day
- Encourage exercise and activity during the day
- Offer warm, soothing, noncaffeinated beverages before bedtime
Promote calmness and orientation:
- Provide a clock and calender and refer to them regularly throughout the day
- Communicate simply about any change in activity, such as time for lunch or time for bed
- Keep familiar and favorite objects around, but avoid a cluttered environment
- Approach the person calmly
- Identify yourself or other people regularly
- Avoid arguments
- Keep noise levels and other distractions to a minimum
- Help the person keep a regular daytime schedule
- Maintain and provide eyeglasses and hearing aids
Prevent complicating problems:
- Giving the person his or her medication on a regular schedule
- Providing plenty of fluids and a healthy diet
- Encouraging regular exercise and activity
Evidence indicates that these strategies help prevent or reduce the severity of delirium in hospitalized people:
- Provide adequate fluids
- Provide stimulating activities and familiar objects
- Encourage the use of eyeglasses and hearing aids, if applicable
- use simple and regular communication about people, current place and time
- Provide appropriate pain management and offer nondrug treatment for sleep problems or anxiety.
Delirium, mental, confusion Homeopathy treatment & Homeopathic remedies:
Belladonna:
Belladonna comes to mind first in delirium. It has a violent delirium with loud laughing screaming out, and grinding of the teeth, and as in all narcotics, a desire to hide or escape. The patient is full of fears and imaginings, and the delirium manifests itself by the most positive ebullitions of rage and fury. Its general character is one of great activity with great excitement, a hot face and head and often times there is present a sensation as if falling and the patient clutches the air. Sometimes there is a stupor, and when aroused they strike people bark and bite like a dog and are most violent.
Hyoscyamus:
This remedy has nit the intensely high degree of maniacal excitement that we find under stramonium, nor as if the cerebral congestion that characterizes belladonna. With Hyoscyamus, there is an aversion to light, and the patient fears being poisoned, he will sit up in bed, talk and mutter all the time, and look wildly about him. There is a great deal of nervousness, whining, crying and twitching, he tries to escape from imaginary foes, a constant picking at the bedclothes and objects in the air is most characteristic. It is the remedy for that curious condition of delirium known as "coma vigil".
Stramonium:
With this remedy the delirium is more furious, the mania acuter and the sensorium more perverted and excited than under belladonna or Hyoscyamus. The patient desires light and company is very loquacious, garrulous, laughs, sings, swears, prays, curses and makes rhymes. He sees ghosts, talks with spirits and hears voices. The head is raised frequently from the pillow, the face is bright red, and he has a terrified expression, in fact, he seems to see objects rising from every corner to frighten him. Sometimes a silly delirium is present.
Lachesis:
Is characterized by great talkativeness in delirium. It has also the fear of being poisoned, but the Lachesis delirium is of a low form accompanied by dropping of the lower jaw, and a characteristic is that they imagine themselves under some superhuman control.
Cimicifuga:
This remedy has loquacity, with a continual changing of the subject when talking, imaginings of rats, mice, etc. It is usually dependent upon uterine disease.
Veratrum album:
Veratrum has restlessness, and a desire to cut and tear the clothing as in belladonna, but with this remedy, there is a coldness of the surface of the body and a cold sweat, the patient is loquacious, talks very loud and is frightened at imaginary things. It also has a state of frenzy or excitement, during which he indulges in shrieks, in expressions of fright and in violent cursings of those around him.
Phosphorus:
The delirium of Phosphorus is a low typhoid type, with a tendency to hemorrhage and an apathetic, sluggish, stupid state, where the patient is unwilling to talk and answers question slowly, imaginary notions, such as imagining that his body is in fragments.
Baptisia:
The patient imagines his body in pieces or double and scattered about, and he has to moves constantly to keep the pieces together.
Thuja:
Here the patient imagines that he is made of glass and move about.
Agaricus:
This remedy highly in the delirium of typhoid fever, where there are constant attempts to get out of bed and tremor of the whole body.
Delirium is a state of mental confusion which develops quickly and usually fluctuates in intensity. A state in which the thoughts, expressions, and actions are wild, irregular, and incoherent, mental aberration, a roving or wandering of the mind- usually dependent on a fever or some other disease, and so distinguished from mania, or madness.
Symptoms:
The signs and symptoms of delirium appear over a short period of time, from a few hours to a few days. They often fluctuate throughout the day so a person may have periods of no reduced awareness of the environment this may result in
- An inability to stay focused on a topic or to change topics
- Wandering attention
- Getting stuck on an idea rather than responding to questions or conversation
- Being easily disturbed by unimportant things
- Being withdrawn, with little or no activity or little response to the environment poor thinking skills
This may appear as:
- Poor memory, particularly of recent events
- Disorientation, or not knowing where one is, who one is or what of day it is
-Difficulty speaking or recalling words
- Rambling or nonsense speech
- Difficulty understanding speech
- Difficulty reading or writing
Behavior changes:
- Seeing things that don't exist(hallucinations)
- Disturbed sleep habits
- Restlessness, agitation, irritability or combative behavior
- Extreme emotions, such as fear, anxiety, anger or depression
Delirium and dementia:
Other medical condition can result in symptoms associated with delirium. Dementia and delirium may be particularly difficult to distinguish, and a person may have both. In fact, frequently delirium occurs in people with dementia.
Dementia is the progressive decline in memory and other thinking skills due to the gradual dysfunction and loss of brain cells. The most common cause of dementia is Alzheimer's disease.
Some differences between the symptoms of delirium and dementia include:
- Onset: The onset of delirium occurs within a short time. While dementia usually begins with relatively minor symptoms that gradually worsen over time.
- Attention: The inability to stay focused or maintain attention is significantly impaired with delirium. A person in the early stages of dementia remains generally alert.
- Fluctuation: The appearance of delirium symptoms can fluctuate significantly and often throughout the day. While people with dementia have better and worse times of day, their memory and thinking skills stay at a fairly constant level during the course of a day.
When to see a doctor???
If a relative, friend or someone in your care shows any signs or symptoms of delirium, see a doctor. If the person has dementia, be aware of relatively sudden changes in overall awareness and engagement. Which may signal delirium. Your input about the person's symptoms, as well as his or her typical thinking and everyday abilities, will be important for a diagnosis.
Older people recovering in the hospital or living in a long-term care facility are particularly at risk of delirium. Because symptoms can fluctuate and some symptoms are "quiet" -such as social withdrawal or poor responsiveness- delirium may be missed. If you notice signs and symptoms of delirium in a person in a hospital or nursing home, report your concerns to the nursing staff or doctor rather than assuming that those problems have been observed.
Causes:
Delirium occurs when the normal sending and receiving of signals in the brain becomes impaired. This impairment is most likely caused by a combination of factors that make the brain vulnerable and trigger a malfunction in brain activity. Any condition that results in a hospital stay, especially in intensive care, increases the risk of delirium.
Common causes include dehydration and infection, such as urinary tract infection. Pneumonia, and skin and abdominal infections. Examples of other conditions that increase the risk of delirium include.
- Previous delirium episodes
- Visual or hearing impairment
- Dementia
- Older age
- Fever and acute infection, particularly in children
- Poor nutrition
- Dehydration
- Severe, chronic or terminal illness
- Alcohol or drug abuse or withdrawal
- Multiple medical problems or procedures
- Treatment with multiple drugs.
A number of medications or combinations of medications can medications can trigger delirium, including some types of:
- Pain medications
- Sleep medication
- Allergy medications(antihistamines)
- Medications for mood disorders, such as anxiety and depression
- Parkinson's disease medications
- Drugs for treating spasms or convulsions
- Asthma medication
Delirium may have more than one causes, such as a medical condition and medication toxicity.
Complications:
Delirium may last only a few hours or as long as several weeks or months. If factors contributing to delirium are addressed, the recovery times are often shorter. The degree of recovery depends to some extent on the health and mental status before the onset of delirium, for example, may experience a significant overall decline in memory and thinking skills. People in better health are more likely to recover fully. People with other serious, chronic or terminal illness may not regain the levels of thinking skills or function that they had before the onset of delirium. Delirium in seriously ill people is also more likely to lead to:
- General decline in health
- Poor recovery from surgery
- Need for institutional care
- Increased risk of death
Tests and Diagnosis:
A doctor will diagnosis delirium based on the answer to questions about a person's medical history, tests to assess mental status and the identification of possible contributing factors.
An examination may include the following:
Mental status assessment:
A doctor starts by assessing awareness, attention, and thinking. This can be done informally through conversation, or more formally with tests or screening checklists that assess mental status, confusion, perception, and memory.
Physical and neurological exam:
The doctor will perform a physical exam, checking for signs of dehydration, infection, alcohol withdrawal and other problems. The physical exam- can also help detect underlying disease. Delirium may be the first or only sign of a serious condition, such as respiratory failure or heart failure. A neurological exam- checking vision, balance, coordination, and reflexes- can help determine a stroke or another neurological disease is causing delirium.
Other possible tests:
If the cause or trigger of delirium can't be determined from the medical history or exam the doctor may order blood, urine, and diagnostic tests. Brain imaging tests may be used when a diagnosis can't be made other available information.
Treatment:
The first goal of treatment for delirium is to address any underlying causes or triggers- by stopping the use of a particular medication, for example, or treating an infection. Treatment then focuses on creating the best environment for healing the body and calming the brain.
Supportive care:
Supportive care aims to prevent complications by protecting the airway, providing fluids and nutrition, assisting with movement, treating pain, addressing incontinence and keeping people with delirium oriented to their surroundings.
A number of simple, nondrug approaches may be of some help:
- Clocks and calendars to help a person stay oriented
- A calm, comfortable environment that includes familiar objects from home
- Involvement of family members
- Avoidance of change in surroundings and caregivers
- Uninterrupted periods of sleep at night, with low levels of noise and minimal light
- Open blinds during the day to promote daytime alertness and a regular sleep-wake cycle
- Adequate nutrition and fluid
- Use of adequate light, music, massage and relaxation techniques to ease agitation
- Opportunities to get out of bed, walk and perform self-care activities
- Provision of eyeglasses, hearing aids and other adaptive equipment as needed.
Medications:
Talk with the doctor about avoiding or minimizing the use pf drugs that may trigger delirium. However, certain drug treatment may calm a person who misinterprets the environment in a way that leads to severe paranoia, fear or hallucinations and when severe agitation or confusion.
- Prevents the performance of a necessary medical exam or treatment
- Doesn't lessen with nondrug treatment
To promote good sleep habits:
- Keep inside lighting appropriate for the time of day
- Encourage exercise and activity during the day
- Offer warm, soothing, noncaffeinated beverages before bedtime
Promote calmness and orientation:
- Provide a clock and calender and refer to them regularly throughout the day
- Communicate simply about any change in activity, such as time for lunch or time for bed
- Keep familiar and favorite objects around, but avoid a cluttered environment
- Approach the person calmly
- Identify yourself or other people regularly
- Avoid arguments
- Keep noise levels and other distractions to a minimum
- Help the person keep a regular daytime schedule
- Maintain and provide eyeglasses and hearing aids
Prevent complicating problems:
- Giving the person his or her medication on a regular schedule
- Providing plenty of fluids and a healthy diet
- Encouraging regular exercise and activity
Evidence indicates that these strategies help prevent or reduce the severity of delirium in hospitalized people:
- Provide adequate fluids
- Provide stimulating activities and familiar objects
- Encourage the use of eyeglasses and hearing aids, if applicable
- use simple and regular communication about people, current place and time
- Provide appropriate pain management and offer nondrug treatment for sleep problems or anxiety.
Delirium, mental, confusion Homeopathy treatment & Homeopathic remedies:
Belladonna:
Belladonna comes to mind first in delirium. It has a violent delirium with loud laughing screaming out, and grinding of the teeth, and as in all narcotics, a desire to hide or escape. The patient is full of fears and imaginings, and the delirium manifests itself by the most positive ebullitions of rage and fury. Its general character is one of great activity with great excitement, a hot face and head and often times there is present a sensation as if falling and the patient clutches the air. Sometimes there is a stupor, and when aroused they strike people bark and bite like a dog and are most violent.
Hyoscyamus:
This remedy has nit the intensely high degree of maniacal excitement that we find under stramonium, nor as if the cerebral congestion that characterizes belladonna. With Hyoscyamus, there is an aversion to light, and the patient fears being poisoned, he will sit up in bed, talk and mutter all the time, and look wildly about him. There is a great deal of nervousness, whining, crying and twitching, he tries to escape from imaginary foes, a constant picking at the bedclothes and objects in the air is most characteristic. It is the remedy for that curious condition of delirium known as "coma vigil".
Stramonium:
With this remedy the delirium is more furious, the mania acuter and the sensorium more perverted and excited than under belladonna or Hyoscyamus. The patient desires light and company is very loquacious, garrulous, laughs, sings, swears, prays, curses and makes rhymes. He sees ghosts, talks with spirits and hears voices. The head is raised frequently from the pillow, the face is bright red, and he has a terrified expression, in fact, he seems to see objects rising from every corner to frighten him. Sometimes a silly delirium is present.
Lachesis:
Is characterized by great talkativeness in delirium. It has also the fear of being poisoned, but the Lachesis delirium is of a low form accompanied by dropping of the lower jaw, and a characteristic is that they imagine themselves under some superhuman control.
Cimicifuga:
This remedy has loquacity, with a continual changing of the subject when talking, imaginings of rats, mice, etc. It is usually dependent upon uterine disease.
Veratrum album:
Veratrum has restlessness, and a desire to cut and tear the clothing as in belladonna, but with this remedy, there is a coldness of the surface of the body and a cold sweat, the patient is loquacious, talks very loud and is frightened at imaginary things. It also has a state of frenzy or excitement, during which he indulges in shrieks, in expressions of fright and in violent cursings of those around him.
Phosphorus:
The delirium of Phosphorus is a low typhoid type, with a tendency to hemorrhage and an apathetic, sluggish, stupid state, where the patient is unwilling to talk and answers question slowly, imaginary notions, such as imagining that his body is in fragments.
Baptisia:
The patient imagines his body in pieces or double and scattered about, and he has to moves constantly to keep the pieces together.
Thuja:
Here the patient imagines that he is made of glass and move about.
Agaricus:
This remedy highly in the delirium of typhoid fever, where there are constant attempts to get out of bed and tremor of the whole body.
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