Description of delirium
Delirium is a mental disease ranking among the qualitative disorders of consciousness. Among its basic manifestations include sensory disturbances (delusions and hallucinations), thought disorder (delusions, and incoherence), emotive disorders (increased or decreased expression of emotions, to apathy) and conduct disorder (restlessness, stupor).
Risk factors for delirium
The cause of delirium is very often a combination of several unfavorable factors. Rarely is causing one of the only blip in an internal environment of the body. The emergence state of delirium occurs primarily in subjects with insufficient supply to the brain oxygen (cerebral hypoxia). This may be due to various injuries (trauma), infections (meningitis, encephalitis, meningoencephalitis) and tumors or swelling of the brain. More often we meet with delirium in elderly people with severe or multiple diseases of internal organs. It is a heart disease (failure, endocarditis), blood vessels (anemia, atherosclerosis), and pulmonary diseases (pneumonia – pneumonia). Other conditions associated with delirium include mineral imbalance in the blood, liver diseases, kidney cancer, pyrexia and poisoning (intoxication). In susceptible individuals may even cause delirium and certain drugs (central anticholinergic agents, chemotherapeutics, opiates, etc.). The greatest significance, however, has advanced age patients, their food and drink (→ dehydration causes delirium, not only myself, but also worsen the impact of other factors) and overall psychosocial status. A major stressor might be pressing financial situation, a change of environment (moving to a retirement home), loss of life perspective, loneliness.
prevention of delirium
Individual removal of the causes of it is very difficult and often present due to dementia almost impossible. It is very important to follow all rules set by doctors for the treatment of disease present, it is regularly and correctly use the prescribed medication, pay attention to proper nutrition and fluid intake. It is particularly important at the level of practitioners, but also the physician prescribing any treatment, evaluate the ability of patient cooperation (ie. Compliance). If we assume a reduced ability to work, we must ensure compliance with the arrangements through family or agency providing home care.
Another preventive measure may be a rich cultural life, meeting with friends and family. For people linked to the home can be enriching and emotional life-saving pet (parrot, guinea pig). Any social and financial standing difficulties will try to resolve in a timely manner, today can be contacted for free agency social and legal assistance. The balance sheet and solving problems is not afraid to use psychological help due to the frequent generational conflicts within the family.
symptoms of delirium
Delirium usually picked up and fade away very quickly, but there are also long-lasting types of delirium. The basic symptom is the quality impaired consciousness. This is manifested by memory loss (amnesia), which is wholly or partly under severity of the condition. People in delirium are disoriented person (not knowing who they are, who is around them), place, time and space; or they do not recognize where and why they are, fail to identify the year, date. They also havespeech disorders and in terms of its loss (aphasia). Mild delirium associated with anxiety and helplessness when a person seeks in a newly created position to readjust and confess (formerly called. AMENCO) With the deepening of state added sensory disturbances – hallucinations (false perceptions), the overall unrest in thought and movement (psychomotor ) leaders as well as aggressive behavior. Abnormal thinking can be expressed only thinking slowdown, or even as adelusion – irrefutable and fierce conviction. Some patients may also suffer from long intellectual impairment (dementia). For patients with no previous failures intellect disorientation are very much alive and active. These are then very constructive in trying to make sense of the situation. They may even act like other people to invent various logical explanation for their situation. In some patients with these conditions often repeated, but it is positive that these conditions after removal of the causes of returning to the previous level thinking (reversible).
Special forms of delirium
Among the chosen form of delirium include known delirium tremens (= trembling), characterized by severe confusion, hallucinations, delusions, motor restlessness, insomnia, wide pupils, heavy sweating, tremor. It occurs mainly during cessation treatments when called. Abstinence syndrome (alcohol, drugs)
Separately he describes so well. Sundown syndrome (syndrome dusk). Especially on geriatric wards (dept. For very old patients) for people with serious brain damage and multiple disease (morbidities) after dark to fully develop a delirious state, which after sunrise again ceases.
Delirium may occur in about 85% of patients in the terminal stages of cancer in particular, so-called. Delirium terminal (terminal = final)
diagnosis of delirium
Examination of delirium performs all physicians interview with the patient or with people from around the patient. When uncertainty can be used in consultation with a specialist in psychiatry.State memory and mental function can be tested by a series of standard tests. Jendním one example. MMStest (Mini-Mental State) that estimates the degree of cognitive (information processing, thinking). Better for the so-called delirium. Delirium Rating Scale, which differentiate delirium from dementia and other psychological disorders. To estimate the ability of the patient, there are a series of tests in psychology and geriatrics (test mobillity, everyday activities, test the nutritional status …).
All these methods require considerable patience, empathy and clinical experience.
treatment of delirium
Therapy, delirium is especially dependent on what the best treatment or removal of the underlying cause. It is necessary to take care of the insufficient blood circulation, remove any infection, reduce the temperature at the balanced and adequate nutrition and fluid intake.
Another necessary step is to control psychomotor agitation and anxiety, including hallucinations and delusions. They did so. Neuroleptics (Tiapride, Tiapridal, Risperidone, Olanzapine, melperon, haloperidol).
Addition to neuroleptics can also use other substances as clomethiazole and clorazepate.
Another form of treatment is to improve the turnover of nutrients in the brain using a drug called nootropics, including piracetam and meclofenoxate.
Finally, the emergence of delirium can be reduced by adjusting the conditions in the department, such as the lights on overnight, easygoing staff, reduce patient transfers, allow as frequent contacts with family and friends.
complications of delirium
Complications state of delirium are especially associated with disorientation, patients can lose, go out of town, they can be aggressive and threatening the people in their surroundings and themselves. During their stay at the clinic can impede treatment plucking cannulas, urinary catheters are prone to falls and injuries. Their behavior can cause psychological distress to both patients and staff and relatives.
Other complications are associated with neuroleptic treatment. These include a strong downturn, movement disorders (Parkinson’s syndrome can resemble), low blood pressure, dry mouth, weight gain, and more.
Other names: Confusion, confusion, drowsiness consciousness