Acute Confusional State or Delirium: Causes, Symptoms, Types, Risk Factors, Diagnosis

If a person is suffering from a decreased awareness of his surrounding environment accompanied by confused thinking then he/she might be a victim of acute confusional state or delirium. Acute confusional state or delirium has a serious effect on the mental abilities of a person. It starts very rapidly inside a few hours to a few days. Acute confusional state or delirium is usually indicated by numerous causing factors such as, long term medical conditions, changes in the metabolic balance (like low sodium levels), alcohol or drug withdrawal, infection, medication, surgery, etc…

The indications of acute confusional state/delirium and dementia are identical, information from the family members or a caregiver is important for a specialist to form a precise diagnosis.

An individual could possibly have acute confusional state or delirium again if they get sick. A person has to watch for the threatening indications that they are getting unwell again – whatever the original cause was. If they are worried they should contact a physician immediately. If therapeutic complications are handled in advance, then acute confusional state or delirium can be prevented from occurring again.

• It involves inactivity, sleepiness and confusion, or distressed and restlessness. Their sleep may be interrupted.
• A sudden change in state of mind and attitude over hours or days.
• Confusion and disorientation may be experienced. They may have trouble on giving attention to a person they are talking to. It is expected that they will not be able to tell a health professional about their sign of illness. They may experience hallucination. They may forget things that just recently happened.

• Signs includes confusion and forgetfulness about time or place. Troubled speaking, such as talking in a way that doesn’t make sense and also difficulty in understanding what others are saying.
• Slow change in attitude and state of mind over months or possibly years.
• They sometimes seemed puzzled. Over time, the individual’s thinking will not be realistic and understandable. As the condition worsens, they will no be able to concentrate at all. They will usually not be able to talk with or interpret others clearly. In some instance, they may have hallucinations which is the hearing and seeing of things that are not real. They are not mindful of events that just happened, and not be able to remember memory of events in the past. They will be forgetful about the people around them, or where they are. They cannot recognize common objects.

A person with indications of acute confusional state/delirium or dementia have to be treated or examined. In some instances, you can help. Family members can inform the health care assistance how the involved person’s mental state differs from his or her normal state. This can be used by the examiner to treat the complication.

Health professionals will examine at various aspects of a person’s condition. They will be asking what medicines has the person taken. They will see to it if the person has infection, or if he or she has a complication that has gotten worse. They may interview the person to ask questions to know about his or her mental state. They may do searches to see if there may be a trigger for acute confusional state or delirium.

Acute confusional state or delirium happens when the typical sending and accepting of signals in the brain gets damaged. This damage is possibly caused by a combination of factors that make the brain defenseless and trigger a breakdown in brain activity.

Acute confusional state or delirium may have one or more causes, for example, a medical state and medicinal toxicity. At times no cause can be found. Potential causes include:

• Certain drugs or medicinal toxicity may cause acute confusional state or delirium.
• Another cause of acute confusional state or delirium is alcohol or drug abuse/misuse or withdrawal.
• A medical illness can cause acute confusional state or delirium.
• Metabolic disproportion, such as low sodium or low calcium may lead to acute confusional state or delirium.
• Acute, chronic or incurable illness.
• Severe infection, specifically in children.
• Exposure to a contamination.
• Dehydration or malnutrition.
• Deprivation of sleep and emotionally distressed.
• Pain.
• Medical procedures or even surgery with the use of anesthesia.

A few list of drugs or combination of medications which can trigger acute confusional state or delirium are:

• Pain drugs.
• Sleeping pills.
• Medications for mood disorders, for example, depression and anxiety causes acute confusional state or delirium .
• Allergy medications (antihistamines).
• Parkinson’s disease drugs.
• Drugs for treating cramps and seizure.
• Medicines related to asthma may cause acute confusional state or delirium.

Signs and symptoms of acute confusional state or delirium normally begins over a couple of hours or days. They often vary throughout the duration of the day, and there might be times of no manifestations. Side effects have a tendency to be worse mostly in the night when it is dull and things look unfamiliar. Essential signs and symptoms include are mentioned below.

Decreased awareness of the environment may result in the following signs and symptoms:

• Not be able to concentrate on a topic or to change topics.
• Getting attached to ideas than to answer questions or conversations.
• Unimportant things can be a distraction and is a symptom of acute confusional state or delirium.
• Seemingly quiet, with less activity or less response to the environment.

Signs and symptoms of cognitive impairment or poor thinking skills in acute confusional state or delirium are:

• Recent events can’t be remembered easily.
• Not knowing himself or herself nor where he or she is a symptom of acute confusional state or delirium.
• Struggles on recalling and speaking words.
• Babbling and talking with no sense.
• Difficulty in speaking or talking.

Symptoms and signs in behaviour changes in acute confusional state or delirium may include:

• Experiencing hallucinations is a symptom of acute confusional state or delirium.
• Behavioral aggressiveness and anxiousness.
• Making unnecessary sounds such as moaning.
• Unsociable around elders.
• Weariness.
• Interrupted sleeping routine.

Signs and symptoms of emotional disturbances in acute confusional state or delirium may appear as:

• Obsessions and anxiety is a sign of acute confusional state or delirium.
• Depression.
• Short-temper or anger.
• A feeling of intense excitement and happiness.
• Unconcern.
• Mood shifts are doubtful and changes quickly.
• Personality changes.

Three types of acute confusional state or delirium have been identified by the experts:

• Hyperactive acute confusional state or delirium. The type which is easily recognized, this may include eagerness, agitation, hallucinations or quick mood shifts.
• Hypoactive acute confusional state or delirium. Includes less movement activities or inactivity and sluggishness. Patient appears to be in a dream state.
• Mixed acute confusional state or delirium. Combination of hyperactive and hypoactive symptoms. From hyperactive to hypoactive the individual changes state quickly or vice versa.

An individual may have both acute confusional state or delirium and dementia and it is hard to recognize. Most of the time acute confusional state or delirium happens in people with dementia.

The continuous declining of memory and thinking capabilities is due to slow dysfunction and brain cells loss. Alzheimer’s ailment is the most common cause of dementia.

Delirium and acute confusional state or delirium have some differences including:

• Onset. Dementia usually begins with relatively minor symptoms that constantly worsens over time. Onset of acute confusional state or delirium occurs within a short time.
• Attention. In the early stage of dementia, the person remains generally alert. Being impaired with acute confusional state or delirium still has the ability to stay focus or maintain attention.
• Fluctuation. Frequently throughout the day, the appearance of acute confusional state or delirium fluctuates. While having a better or worse time of day are experienced by people with dementia. During the course of the day, their memory and thinking skills are somewhat steady level.

See a doctor, if a friend, relative or someone in your care shows signs or symptoms of acute confusional state or delirium. Having an input about the person’s symptom will be important for a proper diagnosis and for finding the underlying cause, as well as for his or her typical thinking and everyday abilities.

In a hospital or nursing home, If you notice signs and symptoms of acute confusional state or delirium in a person, it should be reported to nursing staffs or doctor rather than assuming that those problems have been observed. Risk of acute confusional state or delirium are specifically on older people recovering in the hospital or living in a long-term care facility.

Be ready to answer the doctors numbers of questions to save time to go over on topics you want to focus on. The person may be questioned about:

• Did he or she experience a symptom and when was the time it occured?
• Was there an analysis of dimentia?
• Did you have a fever, cough or unrinary tract infection recently?
• Have they experienced a head injury or other trauma in the recent past?
• Before the symptoms started, what were the person’s memory and other thinking skills like?
• Did the person perform everyday activities well before the beginning of symptoms?
• Does he or she function independently in a routinely manner?
• Are there other medical conditions that have been treated?
• When was the most recent dose of taking prescription medications directly?
• Was he or she taking new medications?
• Does the person used drugs or alcohol recently? Do you know if the person have an alcohol or drug abuse history? Was there a change in pattern of usage, such as increasing or withdrawal?
• Did the person appeared depressed, extremely sad or withdrawn recently?
• Indication from him or her that she or he doesn’t feel safe?
• Are there any signs of mental illness?
• Did the person experienced hallucination?

The risk of acute confusional state or delirium increases to those people having condition that results after a stay in the hospital, especially people who have been in an intensive care or have been operated, for being a resident in a nursing home.

Risk of acute confusional state or delirium increase in conditions like:

• Brain disorders such as dementia, stroke or parkinson’s disease are possible risk factors for acute confusional state or delirium.
• Rsiks factor for acute confusional state or delirium is more in elderly people.
• Episodes of previous acute confusional state or delirium is a risk factor.
• Impairment of visual and hearing.
• Combination of medical conditions increases the risk factor for acute confusional state or delirium.

A test to assess mental status and identify possible contributing factors to acute confusional state or delirium are based on medical history wherein a doctor can diagnose acute confusional state or delirium. An examination may include:

• Mental status assessment test is conducted for diagnosing acute confusional state or delirium. Starting by assessing awareness, attention and thinking skills by the doctor. With conversations, tests or screenings that assess mental state, confusion, perception and memory is done informally.
• Physical and neurological exams are done to diagnose acute confusional state or delirium. To check for signs of health problems and underlying disease, the doctor performs a physical exam. A neurological exam for diagnosing acute confusional state or delirium includes: checking vision, balance, coordination and reflexes. This can help in determining a stroke or another neurological disease have been causing the acute confusional state or delirium.
• Blood, Urine tests and MRI for acute confusional state or delirium. Diagnostic test such as blood, urine and other test are required by the doctor. If diagnosis can’t be made with other available information, brain-imaging can may be used.

Also Read:

• Treatment for Acute Confusional State or Delirium & its Recovery, Prognosis, Complications and Coping