Delirium: A Serious Neuropsychiatric Syndrome

Overview

• Affects primarily older patients with multiple medical issues.
• Up to half of elderly patients in hospitals may experience delirium.
• Can affect anyone, including children, though less common in younger demographics.

Symptoms

Hyperactive Delirium

• Sudden onset of agitation or aggression.
• Incoherent speech, disorganized thoughts, delusions.
• Hallucinations, confusion about location or purpose.

Hypoactive Delirium

• Sluggishness, drowsiness, reduced reactivity.
• Withdrawal, possibly due to hallucinations.

Mixed State Delirium

• Symptoms of both hyperactive and hypoactive delirium.
• Episodes can occur over hours to days.

Delirium vs. Dementia

• Delirium: Sudden onset, temporary, fluctuating symptoms.
• Dementia: Slow mental decline over months/years, generally alert early on, no hallucinations.

Causes and Risk Factors

• Exact mechanism unknown, likely multifactorial.
• Recent surgery patients at risk due to medications and hospital environment.
• Medications: narcotic pain meds, benzodiazepines, hypnotics, anticholinergics.
• Underlying conditions: dementia, constipation, pneumonia, urinary tract infections.

Theories Behind Delirium

• Neurotransmitter imbalance (acetylcholine, dopamine, norepinephrine, glutamate).
• Neuronal membrane depolarization issues.
• Inflammatory cytokines during infection/trauma.

Prevention and Management

• Identify high-risk patients with a multi-disciplinary approach (nurses, pharmacists, physicians).
• Create a home-like environment: reduce noise, ensure proper use of glasses/hearing aids.
• Maintain daily routines: healthy diet, hydration, mobility, sleep habits.
• Prefer non-opiate pain management strategies.
• Avoid restraints and unfamiliar situations.
• Severe symptoms may be managed with Haloperidol or second-generation antipsychotics.

Long-Term Effects

• Increased risk of falls; patients with delirium are up to 6 times more likely to fall.
• Longer hospital stays, more complications, higher mortality rates due to falls and other issues.