What is delirium? | Mental health | NCLEX-RN | Khan Academy


– Delirium is defined as this acute, or like, sudden change in mental state. Which is different from dementia because remember that dementia usually is this, like, gradual
change in the brain. Delirium, just like dementia though, affects things like your
attention, your memory, your cognition and your
consciousness level. But this change will usually happen over the course of hours or days, as opposed to years with dementia. Patients with delirium often have this decreased awareness of their environment and become very confused. So, if you’re having a
conversation with them they might not be able to stay focused on one particular topic
and they might wander, or be easily distracted by something else. Or, they may simply not respond
to the environment at all. They may also have this poor
ability to remember things, especially with respect to recent events. And finally, in some cases
they might have hallucinations, or extreme emotions, like fear, anxiety, anger and depression. Many of these symptoms are
similar to symptoms of dementia. However, with delirium these symptoms can fluctuate throughout the day. So there might be periods
where no symptoms are present and everything’s normal. And then there might
be sudden periods where some or all of the symptoms appear. And with that said, delirium and dementia are different disorders entirely. But because of the
similarities in their symptoms, it can sometimes be
really hard for doctors to distinguish between
delirium and dementia. Especially because delirium can even happen alongside dementia. So, in order to tell the
difference, there are a couple of important things that
physicians will look for. They’ll first try to figure
out when the onset was. That is, when the change
in mental state happened. Delirium is a relatively
sudden change in cognition that seemingly can go
from no symptoms at all, to major symptoms very quickly. Where dementia starts
with these minor symptoms that usually get worse gradually, over the long periods of time. And they might also test
the patient’s attention. Staying focused and maintaining attention is often seriously limited with delirium. Where patients in their early stages of dementia are generally pretty alert. And finally, and probably
most importantly, they’ll try to figure out
if the symptoms fluctuate. Symptoms of delirium can
fluctuate significantly, coming and going throughout the day. If you plotted them on a graph, it might look something like this, where symptoms come and
go relatively frequently. And patients with dementia, though, will have this pretty constant level of memory and thinking skills over time. It might get worse
gradually, but you don’t see this huge fluctuation like with delirium. Cases of delirium are usually
caused by this disruption in the normal sending and
receiving of brain signals. Which, more often than not,
is from the lack of oxygen, or some other substance that
the brain’s used to receiving. And because of this, and unlike dementia, delirium is typically
temporary and reversible. Which is a major distinction. It’s not necessarily
permanent like dementia is. And drugs are a very
common cause of delirium, especially the ones that
tend to cause a change in the way the brain functions, right? Drugs like anticholinergics,
psychoactive drugs and opioides are all culprits. But also it can be
caused by the withdrawal from certain drugs, and from alcohol. Alcoholics may develop
delirium if they suddenly quit drinking alcohol after
drinking for a long time. And this is sometimes
called delirium tremens. Another major cause are
stressful situations. Stressful situations alone might be enough to trigger delirium, especially when they’re paired with drugs. For example, delirium is
common after a surgery. Which is one, usually a
very stressful ordeal, and two, usually accompanied by drugs or sedatives during the surgery, and likely pain medications
after the surgery. Also, other physiologic
conditions that may cause delirium are things like dehydration
and electrolyte imbalances. And infections like urinary
tract infections, pneumonia, skin infections and abdominal infections. Delirium is significantly more common in the older population. Although, it’s unknown as to why, though there are a couple theories. One is that the
neurotransmitter acetylcholine is reduced when the body is stressed, like with drugs or just
stressful situations. Since the amount of the
acetylcholine the brain makes tends to decrease as we age, older people are more susceptible to further drops in acetylcholine levels during stressful situations. Secondly, as we age, the body becomes less able to filter toxins in the blood and prevent them from entering the brain. So, as you age, it may be that more toxins are allowed to accumulate in the brain, therefore, making delirium more likely. Since delirium is, in fact, reversible, it’s super, super important
to have it properly treated. But the treatment given will depend on the underlying cause, right? For example, if dehydration is suspected, administering fluids and electrolytes will help correct the problem. Or, alternatively, if drugs are involved, removal of the drugs may
help resolve the delirium. Often times it’s important to provide supportive care for the patient if they’re susceptible
to cases of delirium, or during their recover from delirium. Keeping patients calm and oriented with their surroundings
is very, very important. The less stressful, the better. Things that are helpful are things like regular verbal reminders of their location and what’s going on, involvement of family members, use of relaxation techniques, and making sure that they’re given proper nutrients and fluids.

12 thoughts on “What is delirium? | Mental health | NCLEX-RN | Khan Academy

  1. Delerium is a large, white, floating head with pitch black mouth and eyes, with yellow pupils. As well as the ability to shape shift, it's face is slowly melting and anything it shape shifts into retains the white skin, black hollow eyes+mouth, and yellow pupils.

  2. Lack of nutrition? As in slow starvation? Less than 500 calroies day for extended time frame?

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