What is delirium, what are its symptoms? (+ Meaning of the term delirium tremens)

Delirium is a qualitative disorder of consciousness . This syndrome occurs for many reasons. They may have a psychological basis, alcoholism, acute intoxication with alcohol or another drug. It can also be caused by another physical illness. The symptoms are varied and are therefore often confused with another psychiatric disorder.

What interests you most: 
What is delirium and what is the meaning of delirium tremens? 
How does it manifest itself? 
How to get to him and cure him? 

Delirium is defined as a non-specific and pathological response of the brain to a variety of negative factors. They directly affect the CNS, the central nervous system. The problem may also arise in another part of the body.

Delirium is most often diagnosed in hospital during hospitalization. It is reported to affect 10-30% of hospitalized patients , especially those  over 65 years of age . Overall, it is reported to occur at a higher rate above this age limit.

In younger people, it is mainly associated with alcoholism or dependence on another substance. A connection with the withdrawal process is common and generally known , and thus as delirium tremens . However, delirium is a complication of both acute intoxication and sometimes pharmacological treatment.

The total abundance in the population is reported to be about 1-2%. However, in the home environment, it is very easily confused with another psychiatric disorder. Like its causes, its symptoms are diverse. Delirium is considered a psychiatric diagnosis. In the international classification of diseases MKCH-10 falls under the designation F 05.

Disorder of consciousness can be

Disorders of consciousness are generally divided into qualitative and quantitative .  In the qualitative,  there is a change in quality, ie the content of consciousness. There is a bad and inappropriate processing of information from the environment. A person evaluates badly and subsequently reacts inadequately. Qualitative disorders of consciousness also contain other terms.

Qualitative disorders of consciousness are also:

• amencia , also confusion , milder than delirium, without hallucinations
• delirium , sudden change with disorientation, agitation, hallucinations
• obnubilization , ie a gloomy state, suddenly arises and subsides, we know it especially after an epileptic seizure

Quantitative disorders of consciousness extend to the scope of consciousness , wakefulness . These are changes in the clarity, vigilance and attention of man. They state a person's ability to respond to stimuli . They are also divided into unconsciousness, sopor and somnolence.

Quantitative disorders of consciousness are divided into:

• somnolence is a state of excessive sleepiness, a person responds to addressing
• sopor  also resembles a state of sleep, however, it awakens to a painful stimulus
• coma , ie unconsciousness , is a profound disorder of consciousness, a person does not respond to external stimuli
• collapse , syncope , fainting , are terms that describe short-term loss, impaired consciousness

TIP: More information about disorders of consciousness and their causes in the article on Health .

What is delirium tremens?

This term is well known in society. Its definition includes a state where withdrawal is accompanied and complicated by a qualitative disorder of consciousness . Both cognitive function and attention deficit disorder. Cognition is the ability to know.

The delirium tremens are optional components such as smoking cessation , i.e. the state of alcohol withdrawal (drugs), it will include the delirium . However, it is not the cause of a neurological disease , such as a stroke or dementia.

Delirium tremens, and thus the withdrawal state, has typical symptoms such as:

• body routes, limbs
• sweating
• feeling sick, ie nausea to vomiting (vomiting)
• extraction on the stomach
• tachycardia
• transient hallucinations
• cramps of the body, of the grand mal type, ie generalized whole-body muscle twitches, cramps
• disorientation
• confusion
• psychomotor restlessness
• sleep disorders
• memory impairment

Interesting information: Magazine article Do you know how alcoholism affects health?

The causes of delirium are diverse . How delirium is formed is not fully understood. Behind him is a disorder of one of the brain structures. Furthermore, neurotransmitters are involved in its outbreak. More precisely, the imbalance between them, that is, between dopamine and cholinergine.

It occurs more often in the elderly. And in young people it is mostly present in abstinent or acute intoxication. It may even be due to pharmacological treatment. Like other diseases, delirium has risk factors that can cause it, especially when combined .

Delirium has a high rate of undiagnosed cases.
About up to two thirds.

Risk factors for delirium :

• polymorbidity, ie the occurrence of several diseases
• older age, over 65 years
• dementia
• male
• drugs
  • sedative
  • opiates
  • narcotics
  • anticholinergics
  • corticosteroids
  • digital
  • drug interactions
• hospitalization
  • surgery
  • postoperative condition
  • anemia
  • as a result of anesthesia
• neurological diseases 
  • stroke
  • cerebral vasculitis
  • tumor
  • epilepsy
  • migraine
• hypoglycemia
• srdcovo - cievne ochorenia, ako je arytmia či srdcové zlyhanie a infarkt myokardu
• endokrinné ochorenia
• chronické obličkové ochorenie
• dlhodobá choroba pečene
• úrazy hlavy, poranenia mozgu
• porucha zraku a iné senzorické poruchy
• infekčné ochorenie
  • meningitída
  • encefalitída
• dehydratácia
• anémia
• bolesť
• podvýživa, čiže malnutrícia
• nedostatok vitamínov B₁, B₃, B₉
• rozvrat vnútorného prostredia
• intoxikácia oxidom uhoľnatým, ťažkými kovmi, organickými rozpúšťadlami
• imobilizácia a strata schopnosti samostatnosti
• nedostatok spánku, teda spánková deprivácia
• emočný stres a ťažký stres
• abúzus alkoholu, liekov a zneužívanie iných návykových látok
• abstinencia od týchto látok

Najčastejšou príčinou delíria v nižšom veku je práve akútna intoxikácia návykovými látkami alebo spojenie s odvykaním od nich. To sú napríklad alkohol, sedatíva, analgetiká či drogy. V dnešnej dobe má tento celospoločenský problém stúpajúcu tendenciu.

Pre intoxikáciu sa uvádza 19 % zastúpenie. Medzi iné dôvody delíria v mladom veku patria úrazy hlavy s 10 %, avšak, najčastejšie je to infekcia, pri ktorej sa udáva 33 %. Spomedzi iných ochorení sa ako hlavný vyvolávateľ vyskytuje demencia, ale aj cievna mozgová príhoda. Ďalej sú to infekcie neurologického systému, úrazy a tumory.

Remember: 
Delirium is not just caused by alcoholism or other psychoactive substances. 
Many other factors / conditions may be involved in its development.

Delirium is typically manifested by impaired ability to concentrate is , and attention span . And it has a fluctuating character . During the day, the intensity of the difficulties changes. Delirium develops suddenly within a few hours, its course is turbulent and then resonates for several days. However, the longest is 6 months. One has amnesia in sections of this period, that is, one does not remember.

The table shows the distribution of delirium according to psychomotor activity

For the diagnosis of delirium, it is necessary that components such as:

• impaired consciousness and attention
• disorder of perception and thinking, ie hallucinations and delusions
• memory impairment, short term
• sleep disorder, namely the cycle of sleep and wakefulness
• emotional changes such as depression, anxiety and irritability

Delirium has a variety of symptoms. One cannot recognize and be aware of reality . Surviving content is poorly evaluated and also incorrectly responds . He is disoriented, he doesn't know where he is, how he got to the place, he doesn't know familiar people and people around him, such as medical staff.

Hallucinations  and  delusions manifest themselves as perceptions of unreal images, sounds, faces, animals and hostile behavior. He feels threatened. Incorrect evaluation is a risk for aggression, which is a threat of escape or attack . Among the physical manifestations, there are, for example, routes of the body , limbs, but also hypertension or tachycardia and sweating.

Psychomotor restlessness may occur in children, as may elderly patients. People in a delirium basically do not perceive their surroundings and reality purely in full consciousness. Their perception is as if blurred, which then manifests itself anyway.

Delirium may have the following symptoms:

• confusion
• chaotic mental activity
• disorientation, by time, place, person
• thought disorder
• perceptual disorder
• hallucinations and delusions
• increased psychomotor activity, and thus restlessness, agitation, anxiety, non-purpose activity
• decreased psychomotor activity, slow perception, general bradypsychism
• attention deficit disorder
• memory impairment, especially short-term
• sleep disorder
• emotional abnormalities, increased irritability
• instability and variability of behavior and mood
  • euphoria
  • anxiety
  • apathy
  • depression
  • aggressiveness
  • their rotation in a short period of time

An article about sleep disorders and a magazine article What are the causes of insomnia .

Delirium is an altered mental state, which can usually be seen by external manifestations , although it is often confused with other mental disorders. Therefore, correct differential diagnosis is important . It is necessary to distinguish it from psychosis or dementia.

The first phase of the examination aims to evaluate the  anamnesis . Furthermore, various test methods are performed  that examine attention, short-term memory, behavior. Diagnostic scales for delirium are helpful . Mental status is being investigated . The aim of the second phase is to reveal the underlying cause.

Consequently, a physical examination is also required . It complements the laboratory blood tests , blood tests. To rule out metabolic or endocrine disorders or infections. They have similar manifestations. The value of glycemia, electrolytes, urea, creatinine is important. 

An examination for the presence of drugs, alcohol or narcotics or psychotropic substances, ie toxicology , is also performed .

Among imaging methods include CT, MRI, X-ray. The electrical activity of the brain is the EEG and the ECG is also important. Several experts cooperate in the diagnosis, namely a neurologist, an internist, a cardiologist, an endocrinologist, and, of course, a psychiatrist. In case of head injuries, also a traumatologist or neurosurgeon.

Equally important is the co-operation of the family when relatives describe the behavior at home. If the difficulties occur outside the home in a social or medical facility, then a description from the staff. The doctor aims to determine the delirium , its cause and then determine the appropriate treatment .

The course of delirium varies from individual to individual. However,  the rapid onset of difficulties is typical  , which in most cases resolve within a few days. Delirium is therefore a transient condition that should not last more than 6 months. Variability is influenced by risk factors, their combination and, to a large extent, human age.

To change the cycle of the day, a person can fall asleep during the day , so the overall symptoms are mild. On the contrary, the difficulties escalate significantly at night . Mental difficulties fluctuate during hours. They are also accompanied by physical symptoms. A person is depressed, then euphoric. He sits down, is passive and then is significantly restless.

TIP: Magazine article on aggression.

Disorientation, hallucinations and delusions can cause a poor assessment of the situation. A person is worried about their health or life. He can run, but he can also attack. Aggression can be manifested towards objects or people.  

In children, it is present in fever, neuroinfections, but also in head injuries. The most common cause in youth is abstinence treatment or acute intoxication. In older age, it can be a sign of physical illness. It is also largely present in the terminal stage of the disease , even a few weeks before death.