Health Talk: The Concept of High Fever.

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Season 2

DELIRIUM

FURTHER EXPLANATIONS

A delirium is characterized by a disturbance of consciousness and a change in cognition that develop rapidly over short period. Symptoms of delirium include difficulty sustaining and shifting attention. The person is extremely distractible and must be repeatedly reminded to focus attention. Disorganized thinking prevails and is reflected by speech that is rambling, irrelevant, pressured, and incoherent and that unpredictably switches from subject to subject. Reasoning ability and goal-directed behaviour are impaired. Disorientation to time and place is common, and impairment of recent memory is invariably evident. Misperceptions of the environment, including illusions and hallucinations prevail. 

Level of consciousness is often affected, with a disturbance in the sleep-wake cycle. The state of awareness may range from that of hypervigilance to stupor or semi coma. Sleep may fluctuate between hypersomnolence and insomnia. Vivid dreams and nightmares are common. Psychomotor activity may fluctuate between agitate, purposeless movements (e.g. restlessness, hyperactivity, striking out at nonexistent objects) and a vegetative state resembling catatonic stupor. Various forms of tremors are frequently present. Emotional instability may be manifested by fear, anxiety, depression, irritability, anger, euphoria, or apathy. These various emotions may be evidenced by crying, calls for help, cursing, muttering, moaning, acts of self-destruction, fearful attempts to flee, or attacks upon others who are falsely viewed as threatening. Autonomic manifestations, such as tachycardia, sweating, flushed face, dilated pupils, and elevated blood pressure, are common.   

The symptoms of delirium usually begin quite abruptly (e.g following a head injury or seizure). At other times, they may be preceded by several hours or days of prodromal symptoms (e.g. restlessness, difficulty thinking clearly, insomnia or hypersomnolence, and nightmares). The slower onset is more common if the underlying etiology is systemic illness or metabolic imbalance. 

The duration of delirium is usually brief (e.g. 1 week; rarely more than I month) and, upon recovery from the underlying determinant, symptoms usually diminish over a 3 to 7 days period but in some  instances may take as long as 2 weeks (Sadock & Sadock 2003). The age of the client and duration of the delirium influence rate of symptom resolution. Delirium my transition into a more permanent cognitive disorder (e.g. dementia) and is associated with a high motality rate (Bourgeois, Seaman, & Servis 2003).

GENERAL CAUSES OF DELIRIUM

The following “mend a mind” mnemonic aid helps you to recall the various possible general causes of delirium. 

M Metabolic Disorder

E    Electrical Disorder

N Neoplastic Disease

D Degenerative Disease

A Arterial Disease

M Mechanical Disease

I Infectious Disease

N Nutritional Disease

D Drug Toxicity       

Below are the conditions that belong to the various categories:

METABOLIC DISORDER

Endocrine gland disorders

Electrolyte imbalances 

ELECTRICAL DISORDERS 

Epileptic disorders 

NEOPLASTIC DISEASE

Benign tumors

Malignant tumors (of the brain or elsewhere) 

DEGENERATIVE DISEASE

Alzheimer’s disease

Huntington’s chorea

ARTERIAL DISEASE

Cerebrovascular accident (CVA)

Degenerative changes of cerebral arteries 

Multiple infarct dementia 

MECHANICAL DISEASE

Head injury or trauma 

INFECTIOUS DISEASE

Encephalitis 

Meningitis

Cerebral abscess

General systemic infections 

NUTRITIONAL DISEASE

Lack of Nicotinic acid 

Lack of Vitamin B12

Lack of Thiamine 

Lack of Folic acid 

DRUG TOXICITY

Alcohol 

Unprescribed medications 

Cocaine 

Marijuana

Watch out for season 3