Introduction

Delirium is drowsiness and disorientation which is acute and sudden (within hours or days).

Delirium itself is not a disease, but rather, a clinical syndrome (set of symptoms) which can result from an underlying disease process or problems. Delirium is the single most common acute condition among the hospitalized adult patients. It occurs in 10-20% of patients in medical and surgical units. The frequency of delirium is very much higher among the elderly, up to 30-40%. It also very common among young children.

There are many causes of delirium including severe physical illness, directly or indirectly involving the brain (for example; infections, injury, poison, etc); or due to drug and alcohol. In the elderly, the most common cause is urinary tract infection.

Signs and simptom

Delirium can be confused with other psychiatric illness such as dementia, depression and psychosis

The core features of delirium are:

• Drowsiness with fluctuating level of consciousness
• Disorientated to time, place and person
• Difficulty in concentration/ attention
• Problems in remembering recent event

Other features include behavior problems such as agitation and aggression; psychotic features including hallucinations and delusions (strange beliefs); mood swings and disturbed sleep.The duration of delirium in the elderly may last longer.

Complications

Majority of patients with delirium recover fully. However the rate of recovery in the elderly varies from 4 to 40% and memory impairment may persist much longer. Delirium can result in prolonged hospitalization and increased risk of mortality. It can lead to higher rates of nursing home placement among the elderly.

Treatment

As delirium is a very serious disorder, it is best that patients are admitted to a hospital. Healthcare providers should have a high index of suspicion for delirium especially among the elderly. Identification and treatment of the source need to be done immediately. Supportive treatment including helping patients to orientate themselves to the environment, giving simple instructions and so on. Other strategies would be to educate family members and encourage them to accompany the patient. Sometimes drug treatment may be used to control psychotic and behavior problems

Prevention

Further episodes may be prevented by addressing the many risk factors such as:

• Individual factors including age, cognitive deficit, comorbid illness and previous episodes.
• Factors relating to operative procedures.
• Specific illnesses such as burns, aids, infections, metabolic changes and so on.
• Pharmacological factors including drug and alcohol withdrawals.
• Environmental factors including stress, social isolation, sensory impairment, prolonged immobility and so on.

Rehabilitation

Following discharge from the hospital, patients may require continuing assessment and management of residual cognitive and functional impairment. This may be in the form of continuing occupational and physiotherapy. Treatment plan must also focus on reducing on going risk factors.