Delirium

Diagnosis

A healthcare professional can identify delirium by analyzing a patient’s medical history and the results of mental state exams. During the diagnosis, the provider also considers potential factors that could have contributed to the development of the disorder. Tests conducted may include:

• Medical history. The provider will inquire as to what has changed recently. Exists a fresh infection? Did they start a new medication? A new pain, such as chest ache, or an injury were there? Were there any headaches or weakness? Aside from alcohol, did they take any prescription or illicit drugs?
• Mental status review. The provider first evaluates cognition, awareness, and attention. One technique to do this is to speak with the person. In contrast, it can entail tests or screenings. Getting information from family members or caregivers can be helpful.
• Physical and neurological assessments. A physical examination looks for indications of illness or health issues. A neurological examination tests reflexes, balance, vision, and coordination. This can assist in figuring out whether the delirium is brought on by a stroke or another illness.
• Urine and blood tests. The identification of certain causes of delirium can be achieved through tests that examine infection, metabolic imbalances, abnormal blood gas levels, liver function, and drug intoxication in both blood and urine samples.
• Electroencephalogram (EEG). Is a diagnostic test that captures the electrical activity occurring in the brain. It is particularly useful in identifying specific seizure disorders, which may exhibit symptoms resembling delirium.
• Imaging: In the most of delirium cases, imaging tests are generally unnecessary. However, if delirium persists without an apparent cause and fails to improve, a brain computed tomography (CT) scan may be suggested. In rare instances, an magnetic resonance imaging (MRI) of the brain might be beneficial for identifying inflammation or detecting minor strokes that could potentially account for the observed symptoms.

Old patients who have meningitis, an infection affecting the central nervous system, the symptoms they exhibit may differ from those seen in younger individuals and can resemble delirium. In such cases, a lumbar puncture is a valuable diagnostic tool that can assist in confirming or excluding the presence of meningitis.

Treatment

The primary objective of delirium treatment is to identify and address the underlying causes or triggers, which may involve discontinuing certain medications, treating infections, or correcting imbalances in the body. Additionally, the focus shifts towards creating an optimal environment for healing the body and soothing the brain. While there is no specific medication or treatment exclusively for delirium, healthcare providers prioritize addressing the identified causes and contributing factors. Measures such as promoting mobility and activity, removing restraints, and closely monitoring and adjusting medications can aid in the improvement of delirium symptoms alongside the treatment of underlying conditions.

Supportive care

Supportive care focuses on minimizing complications and promoting well-being. The following measures can be taken:

• Ensure the airway is protected.
• Provide adequate fluids and nutrition.
• Assist with mobility and movement.
• Manage and alleviate pain.
• Address any issues related to bladder control.
• Refrain from using physical restraints or bladder tubes.
• Minimize changes in the environment and caregivers whenever feasible.
• Involve family members or individuals familiar to the patient in their care.

Medications

When caring for someone with delirium, it is essential to discuss potential medications that may trigger their symptoms with the healthcare provider. They may recommend avoiding or adjusting the dosage of these medications. While some medications may be necessary to alleviate pain contributing to delirium, others can help calm agitation, confusion, or address specific symptoms such as fear or hallucinations. The decision to use medications is based on factors such as their impact on medical examinations or treatment, the safety of the individual and others, and the effectiveness of other treatments. Once the delirium symptoms improve, the medications are usually tapered off or stopped altogether. It is important to note that there are no medications specifically targeting delirium itself, but rather they focus on addressing underlying causes or specific symptoms. Therefore, consulting with a healthcare provider is crucial as they can provide personalized recommendations based on the individual’s unique circumstances and needs.