Aggression can arise from confusion


Brief overview

  • Description: A complex of various psychological and physical symptoms, all of which are physically (organically) caused ("organic psychosyndrome"). Delirium (delirium) occurs particularly often in older patients. Men are more affected than women because they are more prone to alcohol abuse (a potential cause of delirium).
  • Symptoms: Disorders of perception, orientation, consciousness and memory, thought disorders, strong urge to move, excessive cheerfulness and / or anxiety, sleep disorders, irritability, agitation, hallucinations, fever, high blood pressure, rapid pulse, profuse sweating, tremors (tremor), sometimes rapid, deep breathing
  • Causes: febrile infections, disorders of the water and electrolyte balance, diseases of the central nervous system (Parkinson's, epilepsy, dementia, meningitis etc.), alcohol and other drugs, alcohol withdrawal (delirium tremens), metabolic disorders (such as diabetes mellitus), tumors, operations, certain medications
  • Treatment: drug relief of delirium symptoms (with neuroleptics, clomethiazole, etc.); if possible, treatment of the cause of the delirium

Delirium: description

A delirium is also called organic psychosyndrome designated. This term already indicates that both psychological and organic components are involved. In fact, delirium is not a single symptom, but rather a whole complex of symptoms. Delirium has many of these symptoms in common with mental illnesses, but the respective causes are always physical (organic).

Delirium: symptoms

To the typical symptoms delirium include:

  • Disturbances in consciousness and perception, often with impaired memory and loss of orientation. Thinking disorders with cognitive limitations are also included.
  • psychomotor restlessness with a strong urge to move and occasional skidding movements (jaktations). Often there is an escape from bed.
  • exaggerated cheerfulness and / or unfounded fear (mood disorders)
  • sleep disorders
  • easy irritability and agitation
  • Hallucinations. These can be of an optical as well as acoustical nature and often occur especially in cases of withdrawal delirium (delirium tremens).

In addition to these predominantly psychological symptoms, delirium usually also occurs physical signs of illness on. These are caused by the involuntary nervous system and called neurovegetative symptoms designated:

  • Fever up to 38.5 ° C
  • increased blood pressure and accelerated pulse
  • profuse sweating (hyperhidrosis)
  • sometimes excessively fast and deep breathing (hyperventilation)
  • Trembling, also called tremor (especially severe in delirium tremens)

All of the symptoms mentioned occur suddenly rather than insidiously in delirium and can vary greatly over the course of the disease, especially with regard to their intensity. Doctors then speak of one acute onset with a fluctuating course.

Often times, symptoms only take hours or days to subside and eventually go away. If left untreated, however, delirium can have serious cardiovascular and respiratory complications that can lead to death.

Two types of delirium

Doctors differentiate between two forms of delirium:

  • At the hyperreactive delirium there is generally an increased state of excitement. The patients are restless, sometimes aggressive and often show neurovegetative symptoms.
  • Against that hyporeactive delirium characterized by a general slowdown - those affected appear very calm, sometimes even apathetic.

These two variants do not have to be in isolation, but can replace each other at unpredictable time intervals.

Since the symptoms can be so diverse and their severity also vary greatly from case to case, a diagnosis is often not easy. In particular, delirium of the hyporeactive type is often not recognized as such.

Delirium: causes and possible diseases

Put simply, the trigger for the delirium symptoms is an imbalance of certain messenger substances (neurotransmitters) in the central nervous system (CNS). These messenger substances are important for the transmission of signals between the nerve cells (neurons). There are several possible explanations as to why the neurotransmitter balance is out of control in those affected and why, for example, signals that are too strong are sent:

On the one hand, there are substances that have a direct effect on neuronal structures. So influence about certain drugs, alcohol and other Drugs the messenger substances. Under certain circumstances, chemical substances that result from Metabolic disorders arise as well Shifts in the electrolyte balance on the release of neurotransmitters.

According to the inflammation hypothesis, molecules (so-called Cytokines), disrupt the release of neurotransmitters and thus contribute to delirium. There is a certain risk here, especially in the case of systemic inflammation - for example in the form of large infections.

Finally also plays stress a role. This is because it ensures the release of stress hormones (noradrenaline, glucocorticoids), which can affect the CNS.

As mentioned above, delirium is ultimately always based on an organic or external cause. The correct balance of the neurotransmitters is therefore thrown off the rails due to previous illnesses or external influences. These include, for example:

  • CNS disorders: e.g. Parkinson's disease, epilepsy, meningitis, migraines, traumatic brain injury, cerebral haemorrhage, etc. Often delirium also occurs in the context of dementia.
  • Tumor diseases: Especially in the dying phase, delirium is a common symptom in cancer patients.
  • Disorders of the water and electrolyte balance: Possible cause is insufficient fluid intake (especially in older people) or the use of certain medications.
  • Metabolic disorders: e.g. diabetes or thyroid disease
  • Infections and fever
  • Operative interventions Under anesthesia: In the waking up phase after the operations, delirium occurs in some patients (Continuity syndrome).
  • certain drugs, especially those that have an effect on neurotransmitters such as so-called anticholinergic substances (e.g. agents against incontinence, Parkinson's medication, agents against nausea and vomiting).
  • Drugs of all kinds, including alcohol
  • Lack of oxygen (Hypoxia)

In addition, there are a few factors that can promote the development of delirium. These include, for example, chronic sleep deprivation, previous mental illnesses, persistent pain and even reduced hearing or eyesight.

Delirium tremens (withdrawal delirium)

On the one hand, alcohol can lead to delirium due to its effects. However, it happens far more frequently when it is discontinued after a long period of abuse. The delirium tremens then represents the most serious form of so-called alcohol withdrawal syndrome In the case of milder forms, on the other hand, one speaks of a incomplete delirium. In addition to alcohol withdrawal, withdrawal from other addictive substances can also lead to withdrawal delirium, such as withdrawal from benzodiazepines (sleeping pills and sedatives).

As with other forms of delirium, delirium tremens is also due to an imbalance in certain transmitter systems in the CNS. In principle, all of the above symptoms can also occur here, whereby increased hallucinations occur:

  • scenic-visual and tactile hallucinations (example: worms, beetles or white mice run over their own skin)
  • rarer: acoustic hallucinations such as imagined marching music or noises
  • Paranoia and other delusions

The hallucinations in delirium tremens are often related to the everyday life of the patient. The alcohol itself also often plays a role in the hallucinations - the attendant is then mistaken for a waiter who brings the next schnapps.

In addition, the delirium tremens is of course the eponymous tremor in the foreground. The strong tremor is not always present.

Diseases with this symptom

Find out here about the diseases that can cause the symptom:

Delirium: When Should You See a Doctor?

Many patients have been hospitalized for other illnesses for some time before delirium occurs. However, if you notice one or more of the above symptoms in a relative and they occur suddenly, then you should call the emergency doctor immediately. If left untreated, delirium can lead to serious complications. The faster you react, the lower the risk.

Delirium: what does the doctor do?

Usually the doctor can diagnose “delirium” based on the patient's symptoms. With the help of certain test procedures (CAM) the severity of the delirium can then be determined.

Finding the cause is more difficult. Since many different diseases and factors can ultimately cause delirium, it is often not easy to find the trigger. There are also other diseases that show symptoms similar to delirium and must therefore be ruled out.

Careful recording of the Medical history of the patient (anamnesis): What previous illnesses are there? Is there any alcohol abuse? What is the patient's life like? These and other questions are important for the diagnosis of "delirium". What matters most here is the statements made by relatives, as those affected are usually not able to communicate.

Delirium patients then become different depending on their needs Investigations subjected, including, for example:

  • Electrocardiography (EKG) to rule out cardiac disorders
  • Cardiac ultrasound (echocardiography)
  • Measurement of certain laboratory values ​​(electrolytes, kidney function values, inflammation parameters, etc.)
  • Cerebral fluid examination (liquor puncture)
  • Electroencephalography (EEG) to measure brain waves
  • Computed tomography (CT) and magnetic resonance tomography (magnetic resonance tomography, MRI)

Therapy of delirium

Delirious patients must be treated quickly as there is a potentially fatal risk. Various medications can help relieve symptoms of delirium. These include, for example:

  • Neuroleptics (antipsychotics) like haloperidol: They are mainly given for hyperactive forms of delirium.
  • Clomethiazole: This is the most commonly used active ingredient in delirium tremens.
  • Benzodiazepines (Sleeping pills and sedatives): They are mainly used for withdrawal delirium, but also for other forms of delirium.
  • Antisympathomimetics like clonodine and dexmedetomidine: They can counteract anticholinergic substances (possible triggers for an imbalance in neurotransmitters and thus for delirium).

In addition, if possible, the cause of the delirium is treated or eliminated. If, for example, disturbances in the water and electrolyte balance are the trigger, these must be remedied (e.g. by means of infusions).

Important investigations

These examinations help to find out the causes of the symptoms:

Delirium: You can do that yourself

In addition to medication, other treatment concepts also play an important role in treating delirium. The patient's relatives can help in particular. First of all, this already happens through their mere presence:

It is important for delirium patients familiar people to have each other who repeatedly remind them of the current situation, the time and the place and thus help them with their orientation. Also should be a fixed day / night rhythm to be guaranteed. Also regular Touches promote the healing process, as well as one possible calm environmentthat is neither too dark nor too light.

There are also studies that show that relaxing music and Smells can help the patient. Those who take these aspects to heart can help the healing process delirium support.

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