Delirium Is a common and severe neuropsychiatric syndrome with core features of acute onset and fluctuating course, attentional

l deficits and generalized severe disorganization of behavior. Involves other cognitive deficits, changes in arousal (hyperactive, hypoactive, or mixed), perceptual deficits, altered sleep-wake cycle, and psychotic features such as hallucinations and delusions. Often caused by a disease process outside the brain, such as infection (urinary tract infection, pneumonia) or drug effects, particularly anticholinergics or other CNS depressants (benzodiazepines and opioids). Itself is not a disease, but rather a clinical syndrome (a set of symptoms), which result from an underlying disease or new problem with mentation. Predisposing factors: Metabolic Causes a. Hypoxia b. Hypoglycaemia c. Hepatic encephalopathy, uremic encephalopathy d. Cardiac failure, cardiac arrhythmias e. Water and electrolyte imbalance f. Metabolic acidosis g. Fever, anemia, hpovolemic shock Endocrine Cases a. Hypo/hyper pitutairism b. Hypo/hyper thyroidism c. Hypo/hyper parathyroidism d. Hypo/hyper adrenalism Drugs and Poisions a. Digitalis, guanidine and anti hypertensives b. Alcohol, sedatives and hypnotics c. Trycyclic antidepressants and antipsychotics d. Anti convulsants-levo dopa e. Salicylates, steroids and penecilin f. Methyl alcohol and heavy metals Nutritional Defeciencies a. Thiamin, Niacin, Folic Acid and B12 Systemic infections a. Acute or chronic infections (septicaemia, pneumonia and endocarditis) Intracranial Causes a. Epilepsy b. Head injury c. Intracranial infections d. Stroke e. Focal lesions

Miscellaneous Causes a. Post operative states b. Sleep deprivation c. Heat, electricity and radiation Categories: Delirium due to medical condition In this type, the delirium is due to direct physiological consequences of a general medical condition. Substance induced delirium This disorder is characterized by the symptoms of delirium that are attributed to medication side effects. Substance intoxication delirium Delirium arises within minutes to hours after taking relatively high dose of certain drugs. Substance withdrawal delirium It occurs after reduction or termination of sustained usually high dose of certain substances. Delirium due to multiple etiologies It is associated with more than one cause. It may be a result of combined effect of general medication and substance use. Common clinical features: Impairment of Consciousness Is the key feature that separates delirium from most other psychiatric disorders. There is a fluctuation in intensity and symptoms that are often worse at night. The patient may be unmistakably drowsy, they may manifest reduced performance, they may also manifest disorientation to time, place and person. Appearance and behaviour The patient looks unwell and behaviour may be marked by agitation or hypoactivity. Mood Is frequently labile, with perplexity, intermittent periods of anxiety and depression or occasionally of other mood states such and elation and irritability. Speech The patient may mumble and become incoherent. Perception Visual perception is the modality most often affected, Illusions and misinterpretations are frequent. Cognition Memory registration, retention and recall are all affected. Orientation

Orientation to person, time and place will be all disturbed. Concentration Is impaired. Memory There is impaired registration, short term recall and long term recall. Insight Patient will have no understanding of why a psychiatric assessment has been requested. Sleep Insomia begins to occur along with day time drowsiness. Management 4 key steps: Addressing the underlying cause Maintain behavioural control Prevent further complications Support functional needs Physical Interventions General measures to support cerebral function such as intravenous hydration and appropriate nourishment. Supplemental oxygen has been found to be highly effective in patients who develop delirium with pneumonia. Physical restraints, once a mainstay in the treatment of delirium are now used only when all pharmacological and nonpharmacological interventions have failed. Environmental Interventions Environmental manipulations are directed toward providing the right amount of stimulation for the patient, encouraging sleep, maximising the patients ability to perceive the environment accurately, maintaining safety and achieving a familiarity and consistency for the patient. Cognitive Interventions

Reorientation is one of the most easily accomplished cognitive interventions. Psychologic interventions The delusions expressed by a patient should not be directly disputed. Instead, alternative explanations of events should be offered and frequent reassurance should be given. Pharmacologic interventions Administration of Thiamine and IV fluids. Small doses of benzodiazepines or antipsychotics may be given orally or parenterally. Nursing Interventions Assessment Client history Type, frequency and severity of mood swings Personality and behavioural changes Catastrophic emotional reactions Language difficulties Orientation to time, person and place Appropriateness or social behaviour Physical assessment Observe for signs of damage to the nervous system. Observe for evidences of disease of other organs. Health Teaching Educate the families and patients regarding the cause of delirium. Teach them about the importance of safety. Provide reassurance to the family of the patient that delirium is often temporary and is the result of a medical condition, in order to lessen their worries. Suggest that family members visit the patient, usually one at a time, and provide and calm and structure environment.