Delirium Definition, Reason, Symptoms, Treatment & Prevention

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Delirium Definition, Reason, Symptoms, Treatment & Prevention

Understanding

Delirium is a condition that is quite common, especially in elderly patients in the hospital. Delirium is a condition of decreased consciousness with atypical symptoms. This disorder is acute and fluctuating.

The prevalence of delirium is around 23% for hospitalization. Delirium has a bad impact because it not only extends the length of stay and reduces the quality of life of the sufferer, but delirium also increases the mortality rate of the patient.

Reason

Delirium is a complex, multifactorial phenomenon affecting many parts of the central nervous system. One of the mechanisms by which delirium occurs is neurotransmitter deficiency. In addition, hypoglycemia and hypoxia also play a role in the occurrence of delirium. Acetylcholine deficiency can interfere with neurotransmitter transmission in the brain.

In addition, delirium can also occur as a result of stopping substances such as alcohol, benzodiazepines, or nicotine. Predisposing factors for someone experiencing delirium are:

  • Very advanced age
  • Mild cognitive impairment – ​​dementia
  • Disturbance of activity function
  • Sensory disturbances
  • Frailty elderly
  • Drugs (ranitidine, cimetidine, psychotropic ciprofloxacin)
  • Polypharmacy

The trigger factors that are often encountered include:

  • Pneumonia
  • Urinary tract infection
  • Hyponatremia
  • Dehydration
  • hypoglycemia
  • CVD
  • Change of environment (move room)

Diagnosis

To determine the diagnosis of delirium, it can be done through careful observation of the patient’s clinical appearance. Therefore it is necessary to have a true understanding of the clinical picture of delirium. Generally, sufferers come with complaints of reduced attention or attention, psychomotor disturbances, and sleep cycle disturbances that occur in a short time.

The diagnosis of delirium requires five criteria, namely:

  • Disturbed awareness, in the form of decreased clarity of awareness of the environment, with decreased ability to focus, maintain or change attention.
  • The disorder develops over a short period (usually hours to days) and tends to fluctuate in its course.
  • Cognitive changes (such as memory deficits, disorientation, language disturbances) or development of perceptual disturbances that do not account for dementia.
  • The disturbance in the first and third criteria (cognitive impairment) is not attributable to another pre-existing, established or developing the neurocognitive disorder and does not occur in a state of severe reduced level of consciousness, such as coma.
  • Evidence from the history, physical examination, or laboratory findings that indicates the disturbance is due to the direct physiological consequences of a general medical condition, intoxication or withdrawal from a substance (such as a drug or medication of abuse), exposure to a toxin, or due to multiple etiologies.

Symptom

The main symptom of delirium is global cognitive impairment, which is characterized by impaired short-term memory, perceptual disturbances, or thought process disturbances.

In addition, delirium can also show psychomotor features such as:

  • Hypoactive delirium
    As many as 25% will have the clinical appearance of hypoactive delirium. In this type of delirium, the patient will be calm and withdrawn. Sufferers will tend to fall asleep and have a slow response.
  • Hyperactive delirium.
    Sufferers will show a rowdy appearance, restlessness, and slurred speech. In addition, sufferers also often experience hallucinations.
  • Mixed delirium
    The patient shows a clinical picture of either hyperactivity or hypoactivity.

Treatment

The main steps are to assess all possible causes, provide supportive support, and prevent complications. Take care of the patient’s condition so that accidents do not occur during treatment because the patient is in a phase of decreased consciousness. Handling the underlying problem is really needed – for example infection, decreased blood sugar, disorders of being able to defecate (BAB) or urinate (BAK), and immobilization.

Prevention 

​Prevention of delirium can be done by avoiding various risk factors that increase the risk of delirium. Older people (over 60 years) have a higher risk of experiencing delirium.

Avoid taking drugs that increase the risk of delirium, such as ranitidine, digoxin, ciprofloxacin, codeine, amitriptyline (an antidepressant), and benzodiazepines. In addition, the involvement of various different scientific disciplines is needed to solve the problem of delirium sufferers.

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