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You Are Delirious...



A Study of an Uncommonly Common Syndrome


     People often use the word delirious in everyday conversation. The word itself has various connotations, but what do we know about this illness called delirium? Delirium is a case of acute brain failure, where the mind lies in the midst of usual state of wakefulness and a stupor or a coma. Delirium is also known by many as the acute confusion state as it results in alteration of cognition and consciousness, leading to reduced ability to focus, sustain or shift attention (Echeverría and Paul, 2019). There are many among us who do not give delirium the importance it deserves and the severity that it must be treated with. Delirium is potentially preventable and treatable, but under-recognition of the syndrome and the lack of understanding of the underlying pathophysiology has hindered the successful development of therapies.  
     There is no primary cause for delirium and different patients with this syndrome can have different causes. Infections such as pneumonia or urinary tract infections are common causes. Dehydration, certain medications, an over-full bladder and even constipation – either alone or in combination – can also lead to delirium (Lange, 2017). Younger people and children who are very unwell can develop delirium. Delirium is most commonly seen in the intensive care unit (stress, stroke, surgery and certain medical problems increase the risk of delirium).
     According to the DSM-VI the following are the diagnostic criteria for delirium (for a conformed diagnosis):
      1. Disturbance of consciousness (that is, reduces clarity of awareness of the environment) with reduced ability to focus, sustain, or shift attention
     2. A change of cognition or the development of a perceptual disturbance that is not better accounted for by a pre-existing established, or evolving dementia 
     3. The disturbance develops over a short period of time (usually hours to days) and tends to fluctuate during the course of the day
     4. Evidence from the history, physical examination, or laboratory findings indicates that the disturbance is caused by the direct physiological consequences of a general medical condition

      The treatment of delirium includes treating the trigger, such as stopping the medications are the cause. Despite this condition being common there are no FDA approved medications for this syndrome and main treatment methods are based on non-pharmacologic interventions (like adequate fluid intake, reduced sensory input, meditation, etc.)
    The risk factors of delirium include older age (>65 years of age), higher number of medications being taken, dementia or cognitive impairment, history of delirium, neurological disease and stroke. Other risk factors include emotional distress, surgery, sustained sleep deprivation, environment, sensory impairment and metabolic derangement. Males also under a higher risk of delirium as are the people who are under chronic stress. In many cases, the delirium can be prevented. An estimated 30-40% of cases of delirium are preventable if drugs known as percipients of delirium and alcohol can be avoided.  
     A complete recovery from delirium is possible if it is treated at the appropriate time. Delirium is a serious  problem, though it will not directly kill a patient, it increases the probability of death in the patients and often shares comorbidity with other serious medical conditions similar to acute neurological diseases (acute stroke, meningitis, encephalitis, etc.) and intercurrent illness (infections, trauma, HIV infection, etc.). Another factor to consider is that in serious cases, delirium can cause permanent damage to the brain and some of these patients never return to normal (Girard, et al., 2010). People need to be more aware and not be dismissive of the people who are most likely to develop this syndrome. Though there are challenges in diagnosis of people with delirium (Leonard, et al., 2014), awareness would go a long way for the people who see to be suffering from delirium. Delirium is serious and can cause hospitalisation in many elderly patients and should be considered to be a medical emergency until proven otherwise by a relevant medical professional.



BIBILOGRPHY:

     Echeverría, M. D. L. R., & Paul, M. (2018). Delirium. In StatPearls [Internet]. StatPearls Publishing.

     Fong, T. G., Tulebaev, S. R., & Inouye, S. K. (2009). Delirium in elderly adults: diagnosis, prevention and treatment. Nature reviews neurology, 5(4), 210.

     Girard, T. D., Jackson, J. C., Pandharipande, P. P., Pun, B. T., Thompson, J. L., Shintani, A. K., ... & Ely, E. W. (2010). Delirium as a predictor of long-term cognitive impairment in survivors of critical illness. Critical care medicine, 38(7), 1513.

     Grover, S., Lahariya, S., Bagga, S., & Sharma, A. (2014). Incidence, prevalence and risk factors for delirium in elderly admitted to a coronary care unit. Journal of Geriatric Mental Health, 1(1), 45.

     Lange, Peter. (2017, March 16). Explainer: what is delirium and is it dangerous? http://theconversation.com/explainer-what-is-delirium-and-is-it-dangerous-67936

     Leonard, M. M., Agar, M., Spiller, J. A., Davis, B., Mohamad, M. M., Meagher, D. J., & Lawlor, P. G. (2014). Delirium diagnostic and classification challenges in palliative care: subsyndromal delirium, comorbid delirium-dementia, and psychomotor subtypes. Journal of pain and symptom management, 48(2), 199-214.

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