Delirium - Specialists and information

In the past, the term delirium was often equated with states of confusion that occur when alcohol-dependent patients stop drinking. However, delirium (states of confusion) can occur as a result of very different causes.

Below you will find further information and selected specialists for the treatment of delirium.

Definition: What is delirium?

Delirium - also known as a state of confusion - is a temporary mental disorder characterized by disturbances of consciousness, orientation and perception as well as physical symptoms such as sweating, high blood pressure or increased pulse rate.

Symptoms of delirium

The following symptoms may be present in delirium:

• Disturbance of consciousness and orientation (e.g. drowsiness and inability to find one's bearings with regard to time and place)
• Disturbances of perception (e.g. hallucinations, e.g. seeing or hearing things that are not there, such as white mice scurrying around the room) and thinking (e.g. delusional convictions of being poisoned or threatened, or confusion of thought)
• Physical restlessness, increased jumpiness, depressive symptoms and anxiety
• Disturbance of the sleep-wake rhythm with worsening of symptoms at night
• vegetative symptoms in the form of sweating, high blood pressure, rapid pulse, etc.

The onset of delirium is usually acute. The symptoms typically alternate during the course of the day with better and worse phases.

What are the causes of delirium?

It is assumed that approx. 10 to 15 percent of patients on surgical wards and approx. 15 to 25 percent of patients on internal medicine wards and a total of 30 to 40 percent of all patients over the age of 65 develop delirium during the course of their inpatient stay.

Delirium is particularly common in certain illnesses: burns 20 to 30 percent, AIDS 30 percent, heart operations 70 percent, hip joint operations after fracture 40 to 50 percent.

Delirium is common in patients struggling with life in intensive care units @ sudok1 /AdobeStock

The following risk factors exist for the development of delirium:

• age (especially the elderly and infants)
• pre-existing brain damage (e.g. Alzheimer's dementia, vascular dementia)
• alcohol addiction
• diabetes, malnutrition, tumors and other serious physical illnesses
• Treatment with many medications
• fever
• a previously occurring delirium

The most common causes of delirium are

• Excessive doses of medication such as certain antibiotics, antidepressants, tranquilizers (benzodiazepines), Parkinson's drugs, cortisone, antiepileptic drugs
• Withdrawal from drugs (especially alcohol) and medication (especially tranquilizers such as benzodiazepines, e.g. Valium® or Tavor®)
• Diseases of the brain
• Severe physical illnesses

Alcohol delirium usually occurs in the context of alcohol withdrawal @ Nawarit /AdobeStock

How is delirium treated?

Delirium is always an emergency, which is why hospitalization should take place quickly. It is crucial for the treatment to quickly identify the cause of the delirium in order to initiate immediate treatment of the underlying disorder.

In treatment, a distinction is made between measures aimed at treating the underlying physical causes (e.g. control of water and salt balance and blood sugar, cardiovascular monitoring, gastric protection) and measures to treat the psychological symptoms. These include

• Treatment of delusional experiences, hallucinations and agitated states with strong neuroleptics such as Haldol® or Risperdal®
• Treatment of sleep disorders with drowsiness-inducing neuroleptics such as Eunerpan®
• There are special therapy methods for the treatment of delirium in the context of alcohol dependence