Delirium tremens: what it is, causes and treatment

THEdelirium, also called Delirium Tremens, it is a state of mental confusion that arises abruptly, and causes changes in consciousness, attention, behavior, memory, thinking, orientation or another area of ​​cognition, causing a behavior that usually alternates between excessive sleepiness and agitation.

Also known as Acute Confusional State, thedelirium it is related to changes in brain activity, and it usually affects mainly elderly patients hospitalized or with some type of dementia, such as Alzheimer's disease, or people abstinent from alcohol and drugs, although the exact cause is still unclear.

To treat thedelirium it is recommended, initially, to correct the factors that may be triggering this situation, such as treating an infection, adjusting the medication, organizing the environment or regularizing sleep, for example. In the most severe cases, the doctor may also recommend the use of antipsychotic drugs, such as Haloperidol, Risperidone, Quetiapine or Olanzapine.

How to identify

The main symptoms that indicatedelirium are:

  • Inattention and agitation;
  • Drowsiness or apathy;
  • Inability to obey commands;
  • Inversion of the sleep-wake cycle, in which one remains awake at night and sleepy during the day;
  • Disorientation;
  • Do not recognize family members or acquaintances;
  • Memory changes, even to remember words;
  • Frequent irritability and anger;
  • Sudden changes in mood;
  • Hallucinations;
  • Anxiety.

An important feature of thedelirium it is its acute installation, from one hour to the next, and, in addition, it has a fluctuating course, that is, it varies between moments of normality, agitation or drowsiness throughout the same day.

How to confirm

The diagnosis ofdelirium can be confirmed by the doctor, using questionnaires such as theConfusion Assessment Method (CAM), which indicates that the fundamental characteristics for confirmation are:

A) Acute change in mental status;

It is considereddelirium in the presence of items A and B + C and / or D

B) Marked decrease in attention;
C) Change in the level of consciousness (agitation or drowsiness);
D) Disorganized thinking.

It’s important to remember that "Delirium " it is different from "Delirium", because it means a psychiatric alteration characterized by the formation of a false judgment about something, in which the person has a conviction that something is impossible. Furthermore, unlikedelirium, delirium has no organic cause and does not cause changes in attention or awareness.

Learn more about this change in What is it and how to identify the delusion.

Main causes

The main risk factors for the development of thedelirium include:

  • Age over 65 years;
  • Having some form of dementia, such as Alzheimer's disease or Lewy body dementia, for example;
  • Use of certain medications, such as sedatives, sleeping pills, amphetamine, antihistamines or some antibiotics, for example;
  • Being hospitalized;
  • Having undergone surgery;
  • Malnutrition;
  • Dehydration;
  • Abuse of alcohol or drugs;
  • Physical restraint, such as being bedridden;
  • Use of many medications;
  • Sleep deprivation;
  • Change of environment;
  • Having any physical illness, such as infection, heart failure or kidney pain, for example.

In the elderly,delirium it may be the only manifestation of any serious illness, such as pneumonia, urinary tract infection, heart attack, stroke or changes in blood electrolytes, for example, so whenever it arises it must be quickly evaluated by the geriatrician or general practitioner.

How the treatment is done

The main way to treat delirium is through strategies that help guide the person, such as allowing contact with family members during hospitalization, keeping the person oriented in relation to time, giving them access to the calendar and clock and maintaining an environment calm, especially at night, to allow a peaceful sleep.

These strategies encourage a return to awareness and improved behavior. In addition, elderly people who wear glasses or hearing aids must have access to them, avoiding difficulties in understanding and communicating. Check out more guidance on what to do to live better with the elderly with mental confusion.

The use of medications is indicated by the doctor, and should be reserved for patients with significant agitation, representing a risk to their own safety or that of others. The most used remedies are antipsychotics, such as Haloperidol, Risperidone, Quetiapine, Olanzapine or Clozapine, for example. In cases ofdelirium caused by abstinence from alcohol or illicit drugs, the use of sedative drugs, such as Diazepam, Clonazepam or Lorazepam, for example, is indicated.