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Facts about Delirium

What is delirium?

Delirium (or new mental confusion) is a sudden change in mental status, or sudden confusion, which develops over hours to days. It is different from dementia, such as Alzheimer's disease, which is a chronic confusional state that develops and progresses over time.

Features of delirium

Delirium causes consciousness to become clouded and makes paying attention or focusing thoughts difficult. Some people hallucinate or become paranoid because of difficulty with interpreting the environment. Other symptoms may include rambling speech and jumbled thoughts. These symptoms tend to come and go during the course of the day. Confusion regarding day-to-day events, daily routines, and the roles of familiar people is common. Changes in personality can occur. Some persons become quiet and withdrawn while others become agitated or hyperactive. Normal patterns of sleeping and eating are often disrupted.

Causes

Delirium is an especially common and serious problem in hospitalized elderly patients and requires prompt medical treatment. Delirium can slow the recovery process, and may require more time spent in the hospital. Usually a direct cause can be identified, such as drug toxicity, infection, dehydration, kidney or liver failure, thyroid disorders, alcohol or drug withdrawal, anemia, or decreased oxygen. Some medications also cause or worsen confusion.

Treatment

Many symptoms can be reversed when the cause is identified quickly. Treatment is aimed at determining and correcting the underlying problem. Generally the delirium clears within a few days; however, some cases may persist for several weeks or months.

Management Strategies

The person with delirium will do best in a quiet setting, but should not be isolated or abandoned as this may worsen the confusion. Family or close friends are encouraged to stay with the patient while the confusion is severe, particularly at night, as this can be both helpful and reassuring to the patient. Familiar objects from home (ie: photos, blanket, bedside clock) can be helpful in an unfamiliar environment. Good (but not harsh) lighting and soothing music are usually beneficial as well. Glasses and hearing aides, if normally worn, are important so as not to worsen misinterpretation of environment.