Delirium Symptoms
Delirium is a syndrome, or group of symptoms, caused by a disturbance in the normal functioning of the brain. The delirious patient has a reduced awareness of and responsiveness to the environment, which may be manifested as disorientation, incoherence, and memory disturbance. Delirium is often marked by hallucinations, delusions, and a dream-like state. Delirium affects at least one in 10 hospitalized patients, and is a common part of many terminal illnesses.Delirium is functional cognitive impairment - brain dysfunction without permanent changes in brain structure. Other terms for delirium include acute organic syndrome, and acute or toxic confusional state. The causes of delirium are many-fold and include any severe insult to the brain, such as pharmacological intoxication or withdrawal, fever, trauma, or any generalized physiological or biochemical derangement.
Delirium Symptoms
1. The symptoms of delirium come on quickly, in hours or days, in contrast to those of dementia, which develop much more slowly. Delirium symptoms typically fluctuate through the day, with periods of relative calm and lucidity alternating with periods of florid delirium. The hallmark of delirium is a fluctuating level of consciousness.
2. One gentleman, who had already been in the hospital for three days, when asked if he knew where he was, stated the correct city and hospital. He immediately followed this by saying, “but I started out in Dallas, Texas this morning.” The hospital location was some 1,800 miles from Dallas, Texas, and as previously indicated, he had been in the same hospital for three days.
3. Specific behaviors, precipitating events (eg, feeding, toileting, drug administration, visits), and time the behavior started and resolved should be recorded; this information helps identify changes in pattern or intensity of a behavior and makes planning a management strategy easier. If behavior changes, a physical examination should be done to exclude physical disorders and physical abuse, but environmental changes (eg, a different caregiver) should also be noted because they, rather than a patient-related factor, may be the reason.
4. Attention and concentration are impaired in the delirious patient. This is evidenced by distractibility and poor focus on conversation or other activities. These disturbances are easily identified during bedside interview. Specific tests of attention include serial sevens, digit-span testing, spelling the word “world” backwards, and repeating the months of the year in reverse order.
5. Emotional disturbances, such as fear, anger, anxiety or irritability, Disruptive vocalization, such as screaming, cursing or muttering, Increased or decreased activity — constant hand movements (pulling at clothes or bedding), or, conversely, not moving, Disrupted sleeping and waking.
6. Mental confusion and impaired thinking. See free access online books about Confusion below. See detailed information below for a list of 415 causes of Confusion, including diseases and drug side effect causes.
7. Many additional factors are considered in addition to the Substance Intoxication Delirium symptoms in making proper diagnosis, including frequently medical and psychological testing considerations. This information on Substance Intoxication Delirium symptoms and diagnostic criteria are for information purposes only and should never replace the judgement and comprehensive assessment of a trained mental health clinician.
