Delirium

Delirium is a state of mental confusion. It comes on quickly and causes significant changes in a person's thinking and behavior.

People with delirium usually have trouble paying attention to what is going on or knowing where they are. They may become very withdrawn or very emotional and unable to sit still. They may even see or feel things that are not there (hallucinations). Delirium is a sign of a serious underlying medical condition.

What are the causes?

Delirium occurs when something suddenly affects the signals that the brain sends out. Brain signals can be affected by anything that puts severe stress on the body and brain and causes brain chemicals to be out of balance. The most common causes of delirium include:

• Infections. These may be bacterial, viral, fungal, or protozoal.
• Medicines. These include many over-the-counter and prescription medicines.
• Recreational drugs.
• Substance withdrawal. This occurs with sudden discontinuation of alcohol, certain medicines, or recreational drugs.
• Surgery and anesthesia.
• Sudden vascular events, such as stroke and brain hemorrhage.
• Other brain disorders, such as migraines, tumors, seizures, and physical head trauma.
• Metabolic disorders, such as kidney or liver failure.
• Low blood oxygen (anoxia). This may occur with lung disease, cardiac arrest, or carbon monoxide poisoning.
• Hormone imbalances (endocrinopathies), such as an overactive thyroid (hyperthyroidism) or underactive thyroid (hypothyroidism).
• Vitamin deficiencies.

What increases the risk?

The following factors may make someone more likely to develop this condition:

• Being a child.
• Being an older person.
• Living alone.
• Having vision loss or hearing loss.
• Having an existing brain disease, such as dementia.
• Having long-lasting (chronic) medical conditions, such as heart disease.
• Being hospitalized for long periods of time.

What are the signs or symptoms?

Delirium starts with a sudden change in a person's thinking or behavior. Symptoms include:

• Not being able to stay awake (drowsiness) or pay attention.
• Being confused about places, time, and people.
• Forgetfulness.
• Having extreme energy levels. These may be low or high.
• Changes in sleep patterns.
• Extreme mood swings, such as sudden anger or anxiety.
• Focusing on things or ideas that are not important.
• Rambling and senseless talking.
• Difficulty speaking, understanding speech, or both.
• Hallucinations.
• Tremor or unsteady gait.

Symptoms come and go throughout the day and are often worse at the end of the day.

How is this diagnosed?

People with delirium may not realize that they have the condition. Often, a family member or health care provider is the first person to notice the changes. This condition may be diagnosed based on a physical exam, health history, and tests.

• The health care provider will obtain a detailed history. This may include questions about:
  • Current symptoms.
  • Medical conditions that you have.
  • Medicines.
  • Drug use.
• The health care provider will perform a mental status test by:
  • Asking questions to check for confusion.
  • Watching for abnormal behavior.
• The health care provider may also order lab tests or additional studies to determine the cause of the delirium.

How is this treated?

Treatment of delirium depends on the cause and severity. Delirium usually goes away within days or weeks of treating the underlying cause. In the meantime, do not leave the person alone because he or she may accidentally cause self-harm. This condition may be treated with supportive care, such as:

• Increased light during the day and decreased light at night.
• Low noise level.
• Uninterrupted sleep.
• A regular daily schedule.
• Clocks and calendars to help with orientation.
• Familiar objects, including the person's pictures and clothing.
• Frequent visits from familiar family and friends.
• A healthy diet.
• Gentle exercise.

In more severe cases of delirium, medicine may be prescribed to help the person keep calm and think more clearly.

Follow these instructions at home:

• Continue supportive care as told by a health care provider.
• Take over-the-counter and prescription medicines only as told by your health care provider.
• Ask a health care provider before using herbs or supplements.
• Do not use alcohol or illegal drugs.
• Keep all follow-up visits. This is important.

Contact a health care provider if:

• Symptoms do not get better or they become worse.
• New symptoms of delirium develop.
• Caring for the person at home does not seem safe.
• Eating, drinking, or communicating stops.
• There are side effects of medicines, such as changes in sleep patterns, dizziness, weight gain, restlessness, movement changes, or tremors.

Get help right away if:

• The person has thoughts of harming self or harming others.
• There are serious side effects of medicine, such as:
  • Swelling of the face, lips, tongue, or throat.
  • Fever, confusion, muscle spasms, or seizures.

If you ever feel like a loved one may hurt himself or herself or others, or shares thoughts about taking his or her own life, get help right away. You can go to your nearest emergency department or:

• Call your local emergency services (911 in the U.S.).
• Call a suicide crisis helpline, such as the National Suicide Prevention Lifeline at 1-800-273-8255 or 988 in the U.S. This is open 24 hours a day in the U.S.
• If you’re a Veteran:
  • Call 988 and press 1. This is open 24 hours a day.
  • Text the Veterans Crisis Line at 838255.

Summary

• Delirium is a state of mental confusion. It comes on quickly and causes significant changes in a person's thinking and behavior.
• Delirium is a sign of a serious underlying medical condition.
• Certain medical conditions or a long hospital stay may increase the risk of developing delirium.
• Treatment of delirium involves treating the underlying cause and providing supportive treatments, such as a calm and familiar environment.