A condition of severe confusion and rapid changes in brain function, which is usually caused by a treatable physical or mental illness.

Alternative Names

Acute confusional state; Acute brain syndrome

Causes, incidence, and risk factors

Acute confusional states are usually the result of a physical or mental illness and are usually temporary and reversible. Disorders that cause delirium are numerous and varied. They may include conditions that deprive the brain of oxygen or other substances. Delirium may be caused by diseases of body systems other than the brain, by poisons, by fluid/ electrolyte or acid/base disturbances, and by other serious, acute conditions. Infections such as urinary tract infections or pneumonia may trigger delirium in individuals with preexistent damage to their brains (prior strokes, dementia). The more preexistent brain disorders prior to an insult (infection, poisons, electrolyte derangement, lack of oxygen) the higher the likelihood of developing delirium.

Signs and tests

Neurologic examination may reveal abnormalities, including abnormal reflexes and abnormal levels of normal reflexes. Psychologic studies and tests of sensation, cognitive function, and motor function may be abnormal. The specific lesion, extent of damage, and cause of delirium may be indicated by the results of tests and procedures, including, but not limited to:

serum electrolytes

blood chemistry

(

chem-20 )

serum calcium

glucose test

serum magnesium - test

CPK

liver function tests

ammonia

levels

thyroid stimulating hormone

level

thyroid function tests

B-12 level

drug, alcohol levels (

toxicology screen )

urinalysis

blood gas

analysis

EEG

, electroencephalograph

head CT scan

head MRI scan

CSF (cerebrospinal fluid) analysis

chest X-ray

Treatment

The goal of treatment is to control or reverse the cause of the symptoms, which varies with the specific condition causing delirium. The person should be in a pleasant, comfortable, non-threatening, physically safe environment for diagnosis and initial care. Hospitalization may be required for a short time. Stopping or changing medications that worsen confusion , or that are not essential to the care of the person, may improve cognitive functioning even before treatment of the underlying disorder. Medications that may worsen confusion include anticholinergics, analgesics , cimetidine, central nervous system depressants, lidocaine, and other medications (including alcohol and illegal drugs). Disorders that contribute to confusion should be treated. These may include heart failure , decreased oxygen ( hypoxia ), excessive carbon dioxide levels ( hypercapnia ), thyroid disorders , anemia , nutritional disorders, infections, kidney failure , liver failure, and psychiatric conditions (such as depression ). Correction of co-existing medical and psychiatric disorders often greatly improve mental functioning. Medications may be required to control aggressive or agitated behaviors or behaviors that are dangerous to the person or to others. These are usually given in very low doses, with adjustment as required. Medications that may be considered for use include:

thiamine

sedating medications such as clonazepam or diazepam

serotonin-affecting drugs (trazodone, buspirone)

dopamine

blockers (such as haloperidol, olanzapine, Risperdal, clozapine)

fluoxetine, imipramine, Celexa (may help stabilize mood)

Sensory functioning should be evaluated and augmented as needed by the use of hearing aids, glasses, or cataract surgery . Formal psychiatric treatment may be necessary. Behavior modification may be helpful for some people to control unacceptable or dangerous behaviors. This consists of rewarding appropriate or positive behaviors and ignoring inappropriate behaviors (within the bounds of safety ). Reality orientation , with repeated reinforcement of environmental and other cues, may help reduce disorientation.

Expectations (prognosis)

The outcome varies. Acute disorders that cause delirium may co-exist with chronic disorders that cause dementia . Acute brain syndromes may be reversible with treatment of the underlying cause. Delirium often lasts only about 1 week, although it may take several weeks for cognitive function to return to normal levels. Full recovery is common.

Complications

loss of ability to function or care for self

loss of ability to interact

may progress to

stupor or coma

side effects of medications used to treat the disorder

other complications vary depending on the causative disorder

Calling your health care provider

Call your health care provider if a rapid change in mental status occurs.

Prevention

Treatment of causative disorders and conditions reduces the risk of delirium.