Delirium – causes, symptoms, diagnosis, treatment & pathology

Delirium is a common and very serious neuropsychiatric
syndrome. Typically it affects older patients with multiple medical problems, in fact up
to half of all elderly patients in the hospital will have an episode of delirium at some point,
but being said it can affect anyone – even children, even though that’s much less common.
So, what is delirium exactly? Well let’s look at a quick example. Let’s say there
is an elderly man with diabetes and heart disease, who comes into the hospital with
pneumonia. He might be slowly recovering, even about to go home, and then one evening
things change all of the sudden. He might get really hyperactive, and by that I mean
that he may get agitated or aggressive with the staff, mumble or say things incoherently,
and have disorganized thoughts or even delusions, perhaps talking about things that haven’t
happened or happened years ago. He might even hear or see things like hallucinations, and
not know where he is or what he’s doing there. We would call this an episode of delirium,
and it can be really scary for him or someone who is taking care of him, especially the
first time it happens because it can come out of the blue. These are the symptoms of
what we call hyperactive delirium. But there’s also hypoactive delirium which
is like the flip side of the coin. As an example, you might have a woman with a history of chronic
constipation who has recently come out of back surgery. If she has hypoactive delirium
she might feel suddenly sluggish and drowsy, less reactive and sullen, and might look withdrawn,
perhaps because she’s scared of having hallucinations. These symptoms of both hyperactive and hypoactive
delirium can start pretty suddenly and can happen off and on over the course of a few
hours to a few days, with some patients having what they call mix state delirium where they
are sometimes having hyperactive symptoms and sometimes having hypoactive symptoms.
As you might guess, delirium symptoms can be really tiresome for a patient and can make
them sleepy during the day, and keep them up at night – all of which causes massive
disruption to a person’s life and to the lives of their friends and family.   Even though this sounds pretty hard to miss,
delirium can often go unnoticed or confused with other conditions like dementia, which
has some similarities. To help distinguish delirium from dementia, there are some key
differences to keep in mind. Unlike delirium where the symptoms can start pretty suddenly,
patients with dementia typically have a slow mental decline over months to years. Early
on, dementia patients are also generally alert, oriented, have normal behavior, and don’t
have hallucinations. The good news is that unlike dementia, delirium is usually temporary,
resolving when the underlying cause is addressed promptly. Delirium can sometimes resolve within
hours to days. But in other cases, it takes weeks or months to fully resolve. So what causes delirium? Well the exact mechanism
is not well understood, and unlike a lot of diseases there probably is no single cause.
But we do have a lot of clues and these come from understanding the risk factors for getting
delirium in the first place. Patients who have had recent surgery are often at risk
for delirium, and it might be related to the effects of certain medications such as narcotic
pain medication, benzodiazepines, hypnotics, and anticholinergics as well as the underlying
diseases and chronic fatigue from not sleeping well in the hospital. Since delirium can also
cause trouble sleeping, losing sleep can turn into a dangerous cycle that can really worsen
the symptoms. There are a number of risk factors related to the person’s general health as
well, for example elderly patients with multiple medical problems, especially ones like dementia,
constipation, pneumonia, and urinary tract infections are at high risk for having delirium.
But even though we know these risk factors, there isn’t a specific pathophysiologic
mechanism that explains delirium that we know of – currently we only have theories. One
theory is looking at whether the overall level of neurotransmitters like acetylcholine, dopamine,
norepinephrine, and glutamate might cause delirium. Another theory is about how the
neuronal membrane may not be able to depolarize properly in delirium, and therefore can’t
transmit an action potential from one neuron to another. A third theory suggests that it
might also have to do with inflammatory cytokines that are released during an infection or trauma
that might interfere with the neuron’s ability to do its job. There are other theories as
well, and ultimately one or maybe all of these may be involved in the neuropsychiatric changes
that we call delirium. The good news is that there are things that
can be done to help prevent delirium from happening in the first place, and many of
these things can also help calm a patient down when they are experiencing delirium as
well. The biggest key is identifying people at risk, and this is usually done with the
help of multiple members of the team that interact with the patient in different ways.
As a quick example from before, a nurse might notice that a patient hasn’t been sleeping
well, a pharmacist might notice that they are on multiple opiates for pain control,
and a physician might notice that they have a history of delirium in their medical record.
Taken together this is a high-risk patient – and recognizing these high risk patients
often requires perspectives from various members of the medical team. Once you identify patients
at risk for delirium, it’s really important to help them feel as oriented and comfortable
as possible, you can do that by creating an environment similar to their home environment.
Basic things like reducing extra noise and stimulation by turning off the TV so that
they can feel more calm, and making sure that they have their glasses on and that their
hearing aids are working. Maintaining a good daily routine really helps as well – so that
means allowing them to eat healthy meals, stay well hydrated, stool regularly to avoid
constipation, stay mobile and as active as possible, and maintain healthy sleep habits.
This of course applies to everyone but becomes even more important with patients who are
at risk for delirium. Since we know that many patients with multiple medical problems develop
delirium after having surgery, it’s ideal to manage their pain using non-opiate pain
medications, as well as avoiding the other medications that we know can cause problems.
Finally, it’s always ideal to let patients feel like they are in control and avoid using
restraints or putting them in unfamiliar situations. This becomes particularly tricky when it seems
like a patient might be unsafe, but there are medications like Haloperidol or second
generation antipsychotics that can be used to help with patients with really severe symptoms. There are also some serious long-term effects
to think about – one of the most important ones is related to falling down. When patients
are feeling disoriented, agitated, and confused, they can easily stumble and fall – in fact
some studies show that patients with delirium are up to 6 times more likely to fall down.
These falls can lead to all sorts of painful consequences including broken bones, head
injuries, as well as bruises and bleeds. Unfortunately, this is why patients with delirium often end
up having longer hospitalizations, more medical complications, and ultimately higher mortality

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  1. Very good ideo and the team is amazing as well. Good information that can be used many different ways. Thank you!!

  2. thanks for the valuable info and the great way of presentation ..

     If u may allow me , I have a suggestion .. if u may add some references in the video description for textbooks or official websites that u used to gather info , that will add much credibility to ur channel

    Thanks again

  3. To the narrator of this video clip.

    There is absolutely NOTHING WRONG with seeing or hearing things that are not 100% in the physical realm but exist only as spirit.

    Perhaps in the cases of Delirium the patient is hearing and seeing spirit helpers who are trying to help the patient.

    That's the typical observations and judgement from so-called 'Clinical' people.

    My comment to the Clinically-minded…What are you? You are not just a physical body, but also have a spirit (mirrors the shape and clothing of Human or non-Human being) and a soul (a dime sized circular energy form).

    TO deny that Spirit and Soul exists, one can label that person as Delusional.

  4. Great video, I have to teach some students tomorrow, it really gave me some good ideas how to keep them awake during teachig…. Thanks/

  5. This happened to me after throwing up for a week. It's been 7 months since it happened and I'm still having flashbacks from it :/

  6. Thank you so much for all your videos, especially the psychiatry part, they help me in a lot of ways plus, the topics that I see as boring in class are usually discussed here in an easy and enjoyable way. I owe most of my understanding to your videos especially for the major subjects of medschool. Thank you so much! 🙂

  7. VERY nice video. Thanks for producing it! I'm a pharmacy student and I'm about to go to a training period in a nursing home and your videos are a great help as in introduction to this and other neurological conditions. Keep the good job!

  8. Hi guys, I have your video description and title translated in Italian, and there's a mistake: delirium is not a "delirio", wich in Italian is the delusional productive symptom of psychotic disorders 🙂

  9. This is a wonderfully presented explanation of a very complex disease process. One question, what research are you citing when you state that delirious patients are at 6X greater risk for falls? I do not dispute that delirium is one of the greatest fall indicators, I'm just gathering information for a fall prevention program and want to use this statistic. Thank you for all you do!

  10. i suggest that your politic opinion take by yourself if you don't want be inquired by your enemy

  11. Been subscribed for a long time and am just now looking at this…smh! lol ! Great video! i have 1 year of nursing school left and i will be keeping yal's site in mind! Thank you!

  12. sounds like taking care of your parent AT HOME as part of your family as they too fid for you! unless of course you were put in a daycare from 6 weeks after birth and then in school and aftercare till you are ild enough to get yourself home and the rest of the evening the internet can keep you. would YOU really want to end your life in a facility w strangers just going through their rounds?

  13. I know I'm commenting two years after the release of this video, but this channel helps out so much when I need to quickly understand the basics of something for school work, take notes or get facts for a project, etc. This video is 2 years old, and still helping people out

  14. My grandpa is at the hospital and allways thinks he is in a card Game, all of his relatives Deal different with that his deception, how would you deal with this Person and His weird sentences about all things you can do While playing cards?

  15. My step dad been going through this lately, he’s 75 yrs old. Always falling and seeing things. It’s hard for my mom.

  16. Awesome video!! My school doesnt do the best job at explaining these concepts and you guys make it easy to understand!! Thank you!!

  17. My mother started showing strong symptoms of Delirium when she was on a long 13 hours light with me where cabin light were dim and she already had poor vision which increased her symptoms. After 5 hours, she started showing sign of it. We had no clue what it is. At the 9 hours, she had developed very strong symptoms, being disoriented and stuck in things that happened years ago, as well as having hallucination. What might have trigger it for her, apart from dark cabin, is she was having constipation issue for the past 4 days and being on the plane made it worse because she was not used to 'go' in the tiny plain toilet. We did take her to toilet 4 times but she only peed and her problem was no resolved. Having seen this excellent video, which fits my case perfectly, I am sharing my problem so other can learn from it. Many thanks!

  18. My pathophysiology class for nursing brought me here and this was more helpful than reading my book lol I'm still going to read the book though lol

  19. 1. Is someone with dementia and on benzos at risk for delirium? 2. If benzos can cause delirium, how? I mean, specifically how?

    Someone with dementia SHOULD NOT GET HALDOL!

  20. Once someone has developed delirium for what ever reason it was brought out, will they always have delirium now? Say someone developed delirium because of being ill but recovers and delirium is now better. Said person still has the life long disease. Because of having a disease and the onset of first time delirium does this mean the delirium will return?

  21. Thanks Dad currently going through this. Info is gonna help. Me and my mom couldn't figure out the presonality change. Drugs, depression, etc.

  22. My 9 year old cousin has this every night, he would say "I see ants and sometimes weird things on dream, and be awake for a long time, but when he sleeps it stops, this happened when his mother had to take night shifts, im really worried.

  23. uhhh can you suffer from chronic yet mild episodic delirium in early adulthood/adolescences? i find ill feel agitated for about a day, sometimes a week, followed by constant mild confusion, apathy, feeling like i'm in a dream, and foggy thoughts. i wound't call it full delirium because i'm confusion enough to come off as normal but i certainly feel like i'm in a chronic daze state of confusion that is occasionally replaced by refreshing agitation. I come off as normal most of the time unless i'm particularly agitated(irritable, obnoxious, and annoying as fuck).

  24. Correction importante de la présentation au dessous de la vidéo :
    Delirium en anglais ne correspond PAS au délire en français ! Delirium c'est plutôt le syndorme confusionnel ou confusion mentale.

    Le délire en anglais s'appelle delusion !

    SVP corrigez celà pour ne pas induire en erreur les autres.

  25. So I seen little objects like doorknobs morphing into faces. The patterns on my pants jump off the fabric printed text made a human figure and I wasn’t dreaming. Took a 70 mg vyvanse so that’s why I’m Here

  26. Stress causes my delirium with vivid visual hallucinations sometimes loud sounds like bells. Waking up for high school I usually stumbled around my room but instead of seeing my room it would be metallic walls or I’d be somewhere else until my reality finally flashed back to me . Very delirious . Instagram name DreamDeliriously!!

  27. This video explained delirium very well. I am 35 and this develops after my seizures known as ‘post-octal’ delirium. For the past few years, odd behaviour was noticed and I was called all sorts such as ‘nuisance’ ‘non-complaint’ ‘agitated’ ‘confused’ disoriented’ ‘wanders off’ ‘doesn’t listen’ ‘climbs over bed rails’ ‘windows’ and a high risk of falls. This was all at the hospital and the staff were really rough with me. This was not my norms and family noticed it too but nobody had an answer. Then in October 2018 I was diagnosed, by my neurologist, with Postictal Delirium. This then made sense to my family/friends and my medical notes were repetitive in regards to behaviour and very unfortunate the staff were ignorant towards me. My normal self, I am known to be very bubbly, witty, athletic and have a good sense of humour. I get on with everyone from all walks of life. I was never aware of this behaviour until I was at my baseline and sometimes I would find out weeks later from family and friends. I can’t comprehend in words how upsetting this has been for me, especially when you are unaware and vulnerable.
    Unfortunately now, my neurologist is not sure about his diagnosis🤦🏻‍♀️even though this behaviour has only presented after seizures since I was diagnosed, otherwise I’m completely my normal self. This is obviously frustrating especially when the jigsaw piece fitted and now he’s doubting himself although evidence proves it. I’m totally lost with this at the moment. I had a serious accident and fell 15ft after further seizures at home and delirium because my local hospital didn’t follow the treatment plan. I could have lost my life and I’m so blessed and grateful I’m here today fighting my battle and building myself up again.
    Thank you for reading my comments.

  28. nursing homes are prisions for old people where their hevily sedated on psych drugs so they sleep all day and cause no problems

  29. I’m only 14 and when this happened about a year ago and my family thought I was crazy or unstable in a way or something

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