Delirium: Predisposing Factors, Causes and Risk Factors

A significant decrease in mental abilities is called delirium. Thinking becomes confused as a result, and one loses awareness of their surroundings. Within hours or a few days, the disorder usually manifests itself quickly.

Usually, one or more causes can be linked to delirium. A severe or prolonged illness or an internal imbalance, such as low salt levels, may be contributing factors. Various medications, infections, surgeries, alcohol or drug use, or withdrawal, and some medications may also contribute to the illness.

There are situations when dementia signs are mistaken for delirium symptoms. To identify the disorder, medical professionals could look to the input of a family member or caretaker.

It is the most common organic mental disorder. It has an acute onset. The symptoms develop within hours or days. It has a fluctuating course, i.e., the progression of the symptoms may fluctuate.

Read this blog further to get a quick overview of this important topic and enhance your psychiatry preparation.

Predisposing Factors Of Delirium

• Elderly age
• Association with a chronic medical illness
• History of surgical illnesses 
• Postoperative period
• History of substance abuse or alcohol withdrawal (Delirium Tremens)
• Polypharmacy
• Sensory deprivation (Black Patch Delirium)

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Causes Of Delirium

Following are mentioned some of the causes which can lead to delirium:

• Drugs, alcohol, sedatives, antidepressants
• Endocrinal like  Hypothyroidism/hyperthyroidism and hypopituitarism/hyperpituitarism
• Hepatic encephalopathy
• Septicemia, Pneumonia
• Uremic Encephalopathy
• Epilepsy, tumor, or injury
• Heat
• Sleep depreciation
• Metabolic changes like Hypoxia, hypoglycemia, electrolyte imbalance

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Risk Factors Of Delirium

Delirium risks are increased by any illness that necessitates a hospital stay. The majority of the time, this is accurate when a person is in critical care or recovering from surgery. People who are older and those who reside in nursing homes are more likely to have delirium.

The following are a few instances of additional conditions that could raise the risk of delirium:

• Parkinson's disease, stroke, and dementia which are examples of brain illnesses.
• Current instances of delirium
• Hearing or vision impairment
• Illnesses of many kinds

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Complications Of Delirium

Delirium can last for a short period of time that is from a few hours to a number of weeks or months. The rehabilitation process is frequently sped up by addressing the reasons.

The physical and emotional state before symptoms started has some bearing on recovery. After a delirium episode, for instance, people with dementia could notice a general deterioration in their memory and cognitive abilities. The likelihood of a full recovery is higher for those in better health.

It's possible that those who have additional severe, protracted, or terminal illnesses won't ever regain their pre-delirium cognitive abilities or functioning. Delirium is more likely to cause in critically ill patients:

• Loss of health throughout the board
• An inadequate surgical recovery
• Long-term care's necessity
• Increased mortality risk

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Diagnosis of Delirium

• Cognitive impairment in the form of:
  • Memory (recent is impaired while remote is intact)
  • Language is affected
  • Disorientation (Time/Place/Person)
  • Abnormality in Perception (hallucinations, illusions)
• Consciousness and attention- 
  • Impairment of consciousness is depicted by clouding of consciousness, confused state, altered sensorium, and reduced orientation.
  • Impairment of attention is depicted by reduced ability to focus, sustaining/shifting attention.
• Motor disturbances like hyperactivity, hypoactivity, etc.
• Sleep disturbance like decreased sleep, reversal of the sleep-wake cycle
• Emotional & other disturbances that are sadness, depression, anxiety, transient delusions

Other features associated with delirium are:

• Sundowning: Worsening of symptoms in the evening/night.
• Occupational Delirium: The patient may behave as if he is still on his job even after being admitted, i.e., display occupational habits/gestures.
• Flocculation (Carphologia): Aimless picking movements on bedsheets, clothes, etc.

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How can we examine a patient with delirium?

Examination of delirium patients can be performed with the help of the following methods:

• Confusion assessment method- It is a diagnostic tool to identify delirium. It focuses on 4 main areas:
  • Acute onset and fluctuating course 
  • Inattention
  • Disorganized thinking
  • Altered level of consciousness         
• EEG (Electroencephalogram)
• Mini-mental state examination MMSE, which is also known as a cognitive function, can also be used for assessment.

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Treatment Of Delirium

Considering the fact that delirium is reversible, there are certain treatments. It can be treated by treating the underlying cause like:

• Physical support to prevent the patients from getting into accidents 
• Regular orientation to time, place, and person.
• Antipsychotics: For managing delusion, hallucination, and agitation. Some of the drugs that are used are haloperidol and olanzapine.
• Benzodiazepine can also be used for treating insomnia. Benzodiazepines are the treatment of choice for alcohol withdrawal delirium (Alcohol tremens).

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