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DCG chart

Delirium is a serious disturbance in mental health that is characterized by sudden changes in brain function, resulting in altered consciousness, cognitive impairment, and a decreased ability to focus, sustain, or shift attention. It is a condition that affects the brain's ability to think, remember, and reason. Delirium is often temporary and reversible if the underlying cause is treated promptly. However, it is a critical medical emergency that requires immediate attention.

Causes

Delirium can be caused by a wide range of factors, including severe or chronic medical illness, changes in metabolic balance (such as electrolyte imbalance or dehydration), medication side effects, substance abuse or withdrawal, infection, surgery, or trauma. The condition is more common in older adults, particularly those with pre-existing brain disorders such as dementia, but it can occur at any age.

Symptoms

Symptoms of delirium can vary greatly from person to person but generally include:

• Changes in alertness (being more or less alert than usual)
• Confusion about time or place
• Sleep disturbances
• Memory problems
• Difficulty speaking or understanding language
• Changes in mood or behavior, such as agitation or withdrawal
• Hallucinations or delusions

Diagnosis

Diagnosis of delirium involves a thorough medical history, physical examination, and often includes tests to identify the underlying cause. These can include blood tests, urine tests, imaging studies like MRI or CT scan, and sometimes a lumbar puncture. The Confusion Assessment Method (CAM) is a widely used tool for diagnosing delirium.

Treatment

Treatment of delirium focuses on addressing the underlying cause. This may involve:

• Adjusting or stopping medications that might be contributing to the condition
• Treating any infections or other medical conditions
• Providing supportive care to manage symptoms, such as fluids for dehydration, nutritional support, and creating a calm, supportive environment
• In some cases, medications may be used to manage severe agitation or psychosis, although they must be used carefully, especially in older adults

Prevention

Preventive measures can significantly reduce the risk of delirium, especially in hospitalized patients or those undergoing surgery. Strategies include:

• Regular orientation to time, place, and person
• Ensuring adequate hydration and nutrition
• Managing pain effectively
• Minimizing the use of delirium-inducing medications
• Encouraging mobility and physical activity
• Providing visual and hearing aids to those who need them

Prognosis

The prognosis for delirium varies depending on its cause and the overall health of the individual. While many people fully recover once the underlying cause is treated, delirium can have serious long-term effects, including an increased risk of mortality, prolonged hospital stay, and a possible decline in long-term cognitive function.

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