Section One
OVERVIEW OF DELIRIUM
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Defining Delirium
Delirium is a common and serious medical condition that can affect anyone, but it is particularly prevalent among people who are older, have frailty, live with multiple healthcare conditions, and those with cognitive impairments. It’s a state of acute confusion that can be triggered by various stress-inducing events, such as infections, surgeries, changes in medications, sensory deprivation, or even being taken out of one’s familiar environment, like being hospitalised. When someone experiences delirium, they suddenly become disoriented, not knowing where they are, what time it is, or what’s happening around them. It’s like a sudden mental fog that can be quite scary, especially at night.
Delirium is not a disease itself, but a syndrome associated with various health issues. It often develops rapidly over hours or days and typically improves as the underlying condition gets better. People with delirium may appear lethargic, confused, anxious, or even experience hallucinations. It’s a significant concern for healthcare students and practitioners, as it’s linked to worse outcomes and is associated with a higher risk of declining health and death. Delirium is especially common among older adults and those in intensive care units (ICU), affecting up to one-third of hospitalised patients and 80% of ICU patients.
Dr Emma Cunningham discusses a number of topics relating to delirium.
Dr Cunningham Discusses
Types of Delirium
There are various types of delirium, sometimes called hyperactive, hypoactive and mixed. Please hover over the items below to learn more.
Hyperactive Delirium
Hypoactive Delerium
Mixed Delirium
Symptoms of Delirium
Individuals experiencing delirium may encounter symptoms that fluctuate throughout the day, presenting challenges such as:
Sudden confusion emerging over hours or days.
Struggling to pay attention, listen, or absorb information.
Seeming disinterested in surroundings, appearing “out of it.”
Difficulty in thinking or remembering.
Feeling excessively tired or sluggish.
Feeling unsure about time and place.
Heightened sensitivity to light and sounds.
Seeing or hearing things differently than reality.
Perceiving things that are not present, sometimes engaging in actions like picking at bedclothes to remove non-existent dirt or insects.
Experiencing heightened emotional states.
Holding fixed ideas not grounded in reality. For example, fearing harm from healthcare providers or family members.
Question
Answer
Development of Delirium
Play the Drag and Drop game to test your knowledge. This game was designed to be played on Desktop screens and not mobile devices.
Delirium Pathophysiology
The causes and mechanisms behind delirium are not fully understood, but we can think of delirium as a state where the brain doesn’t function properly. Various factors contribute to this, including inflammation, lack of oxygen, and stress on the brain. These factors can expose the brain to harmful substances and create a state where certain chemicals are imbalanced, affecting how the brain works.
Inflammation, which is the body's response to injury or infection, makes
the brain more vulnerable, impairing its function and allowing substances
to enter more easily.
Medications, toxins, and certain chemicals produced by the body during
inflammation can lead to or sustain delirium. Small clumps in the blood
vessels of the brain, made up of fibrin and neutrophils, can cause brief
episodes of reduced blood flow in the brain, especially in people with
vascular diseases.
The brain's normal alertness system, responsible for keeping us awake and attentive,
is disrupted in delirium. This is due to factors like decreased production of a
neurotransmitter called acetylcholine.
Since alertness and attention are crucial for all aspects of thinking, the cognitive
problems seen in delirium can be widespread and varied. Oxidative stress, another
factor, releases a chemical called dopamine in the brain, which is thought to be behind
the perceptual disturbances seen in delirium.
Regarding how the brain's circuits work, delirium is linked to abnormal interactions between
different brain regions. It affects the connections between the biological master clock in
the brain (the suprachiasmatic nucleus) and various other areas. These disruptions in
connectivity align with the symptoms of delirium, such as problems with consciousness,
memory, and mental coordination.
Delirium is also associated with changes in the connectivity of different brain regions,
which might explain some of the cognitive issues seen in delirium.
There's ongoing debate about whether changes in the size and structure of the brain
(cortical atrophy) are directly linked to delirium. Some studies show a connection,
while others don't. However, certain brain changes, like white matter hyperintensities
(bright spots seen in brain scans caused by things like aging, hypertension, inflammation
or other factors) and cerebral infarcts (areas of dead tissue), are consistently
associated with a higher risk of delirium. These changes likely make the brain more
susceptible to shifts in blood flow during physical illness seen in delirium.
Living with Delirium
During delirium, individuals may encounter hallucinations, resembling vivid dreams, leading them to feel as if they are under attack. They might mistakenly believe that their healthcare team is intentionally causing them harm, perpetuating a constant state of fear. Additionally, distorted perceptions of time may make them think that much more time has passed than is accurate in the real world, and these beliefs, though unreal, appear genuine to the person, making it difficult for them to distinguish between reality and delusion.
The video presentation above is a video developed by the Patient Safety Movement and details a person’s experience of delirium.
As part of the development of this e-resource, we sought insights from current healthcare professional students regarding their perceptions of individuals experiencing delirium in clinical practice. An interesting theme that surfaced was the likening of delirium to the Netflix series ‘Stranger Things’ and the mysterious parallel dimension known as the Upside-Down.
This comparison arose because, much like the disorienting and unpredictable nature of the Upside-Down in the TV series, delirium creates a similarly bewildering and altered reality for individuals. The students found parallels in the unpredictability, confusion, and distorted perceptions depicted in ‘Stranger Things,’ reflecting the challenging and unfamiliar experiences encountered by those navigating the Upside-Down of delirium.
Test Your Knowledge
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