Imagine that a loved one, perhaps your mother, father, or grandmother/grandfather, is hospitalized due to illness. The person you spoke to and recognized yesterday suddenly doesn't recognize you, shouts in panic, doesn't know what time it is, or where you are, and behaves very strangely. You would feel very scared and shocked, wouldn't you? In medicine, this kind of sudden mental confusion is called delirium. This is not as rare as you might think. Therefore, it is very important to be aware of this.
Simply put, what is Delirium?
Delirium is a sudden disturbance in brain function . It is a condition that can develop quickly over a few hours or days. It causes a person's ability to think, remember, concentrate, and understand their surroundings to be temporarily impaired.
The important thing is that delirium is not a mental illness. It usually occurs as a side effect of another medical condition, infection, surgery, or medication. This means that if the underlying cause is identified and treated, the condition can often be completely cured.
What are the main types of delirium?
Delirium can be divided into three main types, based on the way the patient behaves.
| Type of delirium | How to identify? (Characteristics) |
|---|---|
| Hyperactive Delirium | These people are very restless, restless . They are always trying to get out of bed, trying to remove the saline tube, screaming, and acting angry. They are difficult to care for. This type is easy to identify. |
| Hypoactive Delirium | These people are very sleepy, like they're bored . They don't talk much, they don't want to eat or drink, they're indifferent to everything. Because these people don't have any problems, sometimes you can ignore this by thinking it's part of the illness. But this is also dangerous. |
| Mixed Delirium | These people may exhibit alternating symptoms of both types mentioned above. They may be very agitated at one time of the day, and very quiet and sleepy at another time. |
What are the symptoms of delirium?
The symptoms of delirium can vary from person to person. They may also come and go, and may be worse at night .
Main visible features:
- Decreased awareness of surroundings: Forgetting where they are (in the hospital or at home), what day it is, and what time it is.
- Inability to concentrate: Difficulty staying focused on one thing, continuing a conversation, and answering questions correctly.
- Memory loss: Forgetting recent events, such as the names of family members.
- Confusion of thought: Conversations are confusing. Jumping from one topic to another.
- Behavioral changes:
- Seeing or hearing things that are not really there (hallucinations) .
- Believing things that are not true, for example, thinking that someone is trying to poison you (delusions) .
- Very restless, irritable, and agitated .
- Or, to be very quiet, lazy, and sleepy.
- Changes in emotions: Suddenly feeling angry, scared, anxious, or very happy. These feelings change quickly.
- Changes in sleep patterns: Sleepy during the day and awake at night. Sleep is completely disrupted.
What are the causes of delirium?
Delirium is not caused by the stress we experience in our daily lives. It is caused by physical stress that is too much for the body or brain to handle. When the brain is deprived of oxygen, nutrients, or the balance of chemicals it needs, the brain stops working properly.
Some of the most common reasons:
- Severe infections: especially urinary tract infections, lung infections (pneumonia).
- Major surgery: Especially after heart surgery or hip surgery.
- Medications: Some painkillers, sleeping pills, allergy medications, or taking multiple medications at the same time.
- Alcohol or drugs: Using them or stopping them altogether.
- Dehydration or nutritional deficiencies.
- Head injuries from an accident.
- Emergency conditions such as heart attacks and strokes.
- Imbalance in salt levels (sodium, potassium) in the body.
- Severe pain.
- Constipation or inability to urinate.
- Hospital environment: Being in an unfamiliar environment, in a windowless room, with frequent sleep disturbances.
Delirium is also more likely to occur at the end of life, especially in those receiving palliative care.
Who is at higher risk of developing this condition?
Although delirium can develop at any age, some people are at higher risk.
- People over 65 years of age.
- People who have previously had a memory-related condition such as dementia .
- People with impaired vision or hearing.
- People who have previously had delirium.
- Those who have undergone major surgery.
- People who use several medications at the same time.
- People with very weak and thin bodies.
How does a doctor find this?
There is no single test to diagnose delirium. A doctor will diagnose it by considering several factors together.
1. Asking the patient's family about the changes in their mental state: How quickly the change in the patient's mental state occurred, what the changes in behavior were. It is very important to clearly explain what you see to the doctor.
2. Examining the patient: You can ask a few simple questions to test the patient's attention, memory, and thinking ability. (Example: What day is it today? Where are you? Can you count back by 10?)
3. Physical examination: The body is checked for infection or other symptoms.
4. Tests: Various tests are performed to find the underlying cause.
- Blood tests (check for infections, saliva levels)
- Urine tests (see urinary tract infections)
- Chest X-ray
- ECG test (checks heart function)
- Sometimes a brain scan (CT/MRI scan)
How is delirium treated?
The main goal of treatment is to find and treat the underlying physical problem causing the delirium . For example, antibiotics for an infection or saline for dehydration.
In addition, methods are adopted to help provide comfort to the patient and keep them calm and safe.
Non-drug treatments
- Create a calm, quiet environment: Turn down the volume on the television, turn off bright lights, and reduce the number of people coming near the patient at once.
- Always talk to the patient: Speak calmly, in simple words. Saying things like, "You're in the hospital, you'll be fine, we're here for you" can help reduce the patient's fear.
- Provide awareness of surroundings: Place a large clock and calendar where the patient can see them. Keep windows open during the day.
- Being close to family: Seeing familiar faces and hearing the voices of loved ones is a great relief for the patient.
- Using glasses and hearing aids: If you have impaired vision or hearing, it is important to provide the correct equipment for your needs.
- Provide good nutrition and fluids.
- If possible, walk around a bit as advised by your doctor: This condition can worsen when you stay in one place.
Treatment with medication
There is currently no specific medication approved for delirium. However, if the patient is extremely agitated and is at risk of harming themselves or others, the doctor may prescribe a very low dose of a type of sedative (antipsychotic) for a short period of time.
Is it possible to completely recover from delirium?
In most cases, delirium resolves completely within a few days or weeks once the underlying cause is treated. However, some people, especially those who are elderly or have underlying conditions such as dementia, may take several months to recover. Sometimes, there may be minor impairments in memory or thinking skills.
Delirium is a frightening experience, both for the patient and for the family watching over them. But with early recognition and proper medical treatment, your loved one can recover.
Take-Home Message
- Delirium is not a mental illness. It is a sudden disturbance in brain function caused by another illness in the body.
- This is a sudden mental confusion that occurs over a short period of time, such as a few hours or days.
- Symptoms can vary throughout the day and may be worse at night .
- If someone close to you, especially an elderly person or someone who is hospitalized, suddenly starts acting confused, don't ignore it. Tell a doctor immediately.
- Treating the underlying cause can often completely cure delirium.
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