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Disease: Delirium Delirium
Category: Psychiatric diseases

Disease Definition:

The state of feverish ecstasy that stimulates artistic creation and spiritual insight is known as delirium. However, medically, the definition of delirium is quite different from the one mentioned above to the extent that it may be frightening.


Usually occurring as the result of another illness, delirium is the decline in awareness, attention and mental clarity. Agitation, aggressiveness and restlessness could be some of its signs and symptoms. But usually, delirium causes indifference to surroundings and sleepiness.


1/3 of people hospitalized over the age of 65, and more than 70 % of older people in intensive care units suffer from delirium. Delirium usually goes unrecognized particularly in people with dementia, despite its frequency.

Work Group:

Symptoms, Causes


Depending on the differences in behavior, there are three subtypes of delirium:

Hyperactive delirium:

In this subtype, the patient shows irritation, agitation, rapid or loud speech, hallucinations and aggressiveness. 

Hypoactive delirium:

Also called the “quiet delirium”, the patient in this subtype shows little or no speech or movement, sleepiness and indifference.

Mixed delirium:

In this subtype, the patient alternates between the states of being quiet and restless.


Throughout the day, symptoms of delirium can come and go, becoming more severe in the evening and at night. Signs could include:


  • Confusion
  • Constantly shifting attention
  • Hallucinations, which could include visual or hearing
  • Disrupted sleeping and waking
  • Rambling, disorganized or incoherent speech
  • Disorientation
  • Inability to name objects or learn new information
  • Emotional disturbances such as fear, irritability, anxiety or anger
  • Disruptive vocalization, such as screaming, cursing or muttering
  • Increased or decreased activity — constant hand movements (pulling at clothes or bedding), or, conversely, not moving at all.


Although dementia, including Alzheimer's disease, and delirium share many of the same symptoms, dementia develops more slowly and is everlasting. Alert state with decreased memory is the landmark of dementia. 


No exact reason lies behind delirium but factors play a role. A set of changes or stresses can meet to trigger an episode of delirium in vulnerable people, such as a frail older person. A new medication, job loss, sleeplessness and change in environment all can contribute to cause delirium when the body is already acutely stressed by blood loss, dehydration, infection or heart attack.   
Medications trigger delirium more than other things. They could include:


  • H-2 blockers
  • Antipsychotics
  • Muscle relaxants
  • Benzodiazepines
  • Sleep medications
  • Antidepressants
  • Urinary medications
  • Anti-emetics
  • Antihistamines
  • Pain medications


Other causes of delirium include:


  • Infection
  • Sleep deprivation
  • Low oxygen level
  • Alcohol withdrawal
  • Constipation or fecal impaction
  • Dementia, along with a change in environment.
  • Metabolic changes due to blood loss, dehydration, heart disease or other changes in body chemistry.


Delirium and dementia often overlap. 2/3 of people who develop delirium have dementia and the two illnesses may share common roots.



The patient could recover from delirium within hours and days, but sometimes symptoms could last for months and even years. If the reasons behind delirium are curable, then recovery inclines to be faster and more perfect. Almost ¼ of people with delirium suffer long-term memory, cognition and attention problems. Delirium could be the slow match for dementia, but for people who already have dementia, a dramatic drop in cognitive functions could be caused by an episode of delirium.


Long ago, people linked delirium to a declining disease or approaching death. Until now, death rates remain high for ill old people. About 20 % to 75 % of hospitalized patients with delirium die during their hospital stay. 35 % to 40 % of all people who had a delirious episode die in one year.


Addressing the underlying causes or triggering factors is the main goal of treatment for delirium; this could be done by treating an infection or stopping the use of a particular medication. Until now, there's no medication that can treat delirium.


The purpose of treating delirium is to go for the reasons behind it like stopping the use of a certain medication or treating an infection. Yet, no medication has proved effective in treating delirium itself. The treatment mainly focuses on creating the best possible environment for calming the brain and healing the body.



It aims at preventing complications from worsening by:


  • Treating pain
  • Protecting the airway
  • Addressing incontinence
  • Assisting with movement
  • Providing fluids and nutrition
  • Keeping delirious people oriented to their surroundings.



A lot of handy simple approaches were found helpful; such as:


  • Involvement of family members
  • Opening the blinds during the day
  • Avoiding changes in surroundings and caregivers
  • Avoiding bladder tubes and physical restraints
  • Regular verbal reminders of location and what's happening
  • Providing a calm, comfortable environment that includes clocks, calendars and familiar objects
  • Giving opportunities to get out of bed, walk and perform self-care activities
  • Uninterrupted periods of sleep at night, with low levels of noise and light
  • Using music, massage and relaxation techniques to ease agitation
  • Provision of glasses, hearing aids and interpreters as needed



Drug treatment is usually reserved only for people who are very nervous and pose a peril to themselves, to ensure they're quiet enough to be cared for safely. Antipsychotic medications are usually used, which is believed to be beneficial in treating the disorganized thinking that accompanies delirium.


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