Delirium

Delirium is a pathology that characterizes the confusion of consciousness, an etiologically nonspecific organ-mediated cerebral syndrome. The term delirium is like the Latin word-building, insanity, delirium, and absolutely correlates with this ancient term. Delirium is a very common form of obscuration of consciousness, the cause of which can be a variety of diseases, not always caused by a specific nature.

According to Jaspers, the data of the darkened consciousness include: alienation from the environment, disorientation, amnesia of the period of pathological consciousness. Disorientation can be varied and this degree of obscuration affects the characterization.

What is delirium?

Consciousness is the highest form of representation of reality and it is the product of the activity of the brain. Human consciousness is formed under historical development, displays real world events and uses knowledge to process information. But when there are some pathological changes, our consciousness can play a cruel joke. Delirium is one such example.

Delirium is a psychotic disorder. Such a psychoproductive symptom manifests itself as a disturbed consciousness, but this can be a different measure. It is important to remember that delirium is a vivid experience that fills the human mind with various images, sounds, and sometimes even tactile sensations. To this difficult situation, decompensation of cerebral functioning is always involved, but this condition is reversible. That is, if you help a person, he will come out of delirium and will be completely healthy. This condition is similar to the acute insufficiency of any other organ, a kind of equivalent. This is a subtype of passing psychiatric disorders, since basically a person is cured without a trace.

Delirium in the population has a prevalence depending on the age, after 55 years more than one percent of individuals have been transplanted in the history of delirium.

Delirium was known even before the birth of Christ. He was introduced by the wise Aul Cels, who was very interested in mental patients. But until our time this term has changed significantly in its meaning, now it's not just delirium and hallucinations. To him still carry a large number of forms of impairment of consciousness, these are the elements of its deactivation and stunning, as coma, coprofic states. Such patients can bring danger to the environment, and also are dangerous for themselves.

Causes of delirium

Delirium is quite a polyethological state, accounting for a lot of pathologies in its causes. To simplify the classification, it is most convenient to subdivide the causes into subgroups.

Somatic pathology, especially provoking serious intoxication, can lead to this unpleasant state. Infectious diseases, especially those accompanied by fever, can become a provocation. Typhoid fever, having a fecal-oral method of infection and causing hectic temperature jumps. Diseases from the category of acute respiratory, especially influenza, since with it the highest degree of intoxication. Pneumonia is also a fairly common cause, a similar case even described in Goethe's "The Forest Tsar" verse. Streptococcal infection, in particular caused by group A, rheumatism, septicemia, beshiha. Severe protozoal diseases, common in hot countries, for example malaria, which is accompanied by damage to erythrocytes. Hepatitis, especially with progression to liver failure also serve as a cause. AIDS and severe immunodeficiency are also at risk. Insufficiency of the internal organs: renal, cardiac and even acute pathology: heart attacks, strokes can aggravate such symptomatology. All acute surgical pathology: appendicitis, peritonitis, intestinal obstruction, as well as acute gynecological conditions complicate these symptoms. This problem is possible in the postoperative state, especially if the patient experienced hypoxia, because toxins from such accumulate.

Neurological pathology is also very often consonant in the context of delirium. Thus, in herpetic encephalitis, these characteristic disorders are observed. Often, both bacterial meningitis, viral meningoencephalitis, tuberculosis also lead to severe neurologic symptoms with delirium inclusions. Dangerous can be meningococci, rarely other cocci flora. Tuberculosis, affecting the nervous system, is diagnosed with difficulty and causes many changes at the organism level. This pathological condition can complicate chicken pox, cytomegalovirus and Epstein-Barr virus. A variety of hematomas, hemorrhages, in particular, subarachnoid, as well as hemorrhagic stroke. Neoplastic processes with accommodation in the brain, various head injuries, including postpartum haematomas, as well as epilepsy, vascular pathology, aneurysms of blood vessels in the brain. When burns, especially large areas, also develops intoxication syndrome, so in these hospitals you can find delirium.

Delirium is also a subspecies of acute psychoses in vascular dementias after atherosclerosis and hypertension. Neoplasia of the brain, and sometimes of other localization in case of complication with cancer intoxication, can provoke states of obscuration. In general, when identifying such symptoms it is necessary to look for organic lesions in the brain tissues, because there is a high probability of its presence, especially in the brain stem, its upper parts, temporal lobes.

Intoxic delirium is also not uncommon. Poisoning can be as a medicine for anesthesia, barbiturates, an overdose of sleeping pills, stimulants of the nervous system, caffeine, atropine, camphor. Alcohol delirium or vice versa, the white fever is delirium for abstinence. Drugs can also cause such formidable pathologies, even amphetamines and marijuana.

The basis of the pathogenesis of delirium is acute brain damage, which leads to an abnormal metabolism of neurotransmitters in the brain. Due to the pronounced external and internal influences, all this leads to decompensation of brain functions. Neurotransmitters over-stimulate individual parts of the cortex, so in delirium a person observes a variety of imaginative pictures, sometimes hears sounds, phrases. This state greatly captures the attention of a person.

Symptoms and signs of delirium

Acute delirium is mainly a complication of somatics, so when diagnosing it is necessary to look at the underlying pathology. When infections occur their own symptomatology. With typhoid - diarrhea, vomiting, dehydration. With hepatitis - jaundice, bitterness in the oral cavity, changes in urinary indicators and feces. In ARI there are phenomena of catarrh. Temperature is a nonspecific sign of intoxication, present in virtually any pathology that is capable of provoking delirium. With tumors - aversion to meat, sharp weight loss.

In neurological pathology with delirium, it is also important to find the root cause. If this is encephalitis, then focal symptomatology is always observed, with meningitis symptoms of increased intracranial pressure. For the diagnosis of neurotuberculosis, it is important to study the cerebrospinal fluid, due to its individual characteristics.

Symptoms of obscuration of consciousness stand in the first place in the case of delirium. There is disorientation, it is important to understand that the person is oriented in himself, but the location and time are more complicated. Therefore, you need to ask the individual to give a name, when he says his name, ask where he is and what date. He will not be able to answer these questions. It is absolutely obvious that the individual is not able to analyze the events in which he is staying, by virtue of his alienation from the environment, and is in the world of his painful experiences. Amnesia is an essential symptom of this condition, but it has its own characteristics. Amnesia is not complete, that is, the individual partially remembers what happened to him. An important symptom here is that he remembers his hallucinatory experiences much better than the real past.

Acute delirium due to alcoholism has a term of white fever. In this case, hallucinatory experiences are very characteristic. Outwardly the person looks as if something is crawling over him, he is throwing something off his clothes, driving him away, he is very afraid. At this point, patients mostly see small and unpleasant animals and insects, mice, moths. This condition continues for several days, and always gets worse by the evening. For this type of delirium, vegetation is very characteristic: severe tremor, sweating, reddening of the face.

It is characteristic that under such conditions all instincts are very weakened, the person practically does not sleep, his appetite is poor.

Mussified delirium manifests itself in a slightly unusual symptomatology, so it is also called burding delirium. The man is excited, but within the bed, the movements are ridiculous.

The old delirium mainly occurs in the context of senile psychosis and vascular dementia and is mostly much poorer in bright images, all hallucinations are simple, not so imaginative.

Heavy delirium has two main forms - it is mutated, or bubbling and professional. They are similar in many respects, but with a professional, instead of a standard robbery, the person performs professional actions: sews, saws, etc. The professional delirium is explained by the fact that the professional skills of a person can be kept very long and even with disorientation the cortex remembers professional activity, And performs the movements characteristic for his work.

Abroad, psychiatrists like to use a variety of diagnostic scales and delirium in this case is no exception. There are many of them, intended for use by different doctors. Their main goal is to reveal the signs of confusion and to understand what degree of its expression and what kind of cognitive impairment it entails.

Types of Delirium

Delirium is divided into a variety of principles. For reasons it can be: traumatic, narcotic, cocaine, alcoholic, drug, associated with the anamnestic reception of certain chemicals.

Atropine delirium, in addition to the usual affect of fear, is also accompanied by signs of atropine poisoning, dry mucous membranes, tremors, and stool retention. Toxic can also include tofranilovy, tetraetiltsvintsovy, with the presence of hallucinatory experiences in the form of hair in the mouth, opium.

Alcoholic delirium in addition to the typical species known as the white fever, has an atypical version called delirium without delirium. At the same time, the personality is dispersed, but there are no hallucinations. To a similar type can be attributed lucid delirium, which is characterized by the presence of light intervals between pathological experiences.

Auditive delirium is also a subtype of alcoholic, but with it a pronounced hallucinosis is clearly expressed. To them also belongs the delirium of the siege, in which the individual, escaping from unreal pursuers, barricades the passages.

Older delirium occurs in older people. Infectious delirium is associated with an infection that is organic when pathological brain organics are detected. Even hysterical, epileptic and schizophrenic subspecies can be more rarely detected. Hysterical arises always psychogenic and is accompanied by mannerisms and erotic experiences.

Oneiroid delirium is a transitional state in a heavier manifestation of obscuration - an onyroid. This, as it were, the bordering state, hallucinations become scenic, the personality is slowly immobilized. Their characteristic feature - hallucinations become filled with a more religious or mystical composition.

Initial delirium occurs when infection begins. Hypnagogic delirium, or delirium with closed eyes, belongs to the initial form, arises when flowing from wakefulness to sleep. It is difficult, survived this, quickly return criticality, so the person for a while does not realize what happened. Can move into more unfavorable forms. Delirium of collapse or residual occurs when the body temperature falls sharply, and febrile - on the contrary.

Also delirium can be subdivided according to complexity, namely:

- The easiest abortive, or non-deployed delirium manifests itself as hallucinatory images and illusions, delusions, but its orientation is preserved. Lasts not more than a few hours.

- Heavy delirium, having two subspecies, indicates a significant load of consciousness.

- Muted delirium looks like chaotic excitement, but is limited to bedding. In this case, the person screams out incoherent phrases, words. Movement is meaningless: patients pull the sheet, clothes, grasping movements.

- With professional delirium, all movements and actions are automated, the defilement of consciousness is deeper. The patient can clog the non-existent nails, saw. Hallucinations are inexpressive and very stereotyped. All these actions for the person are familiar, he works at a convenient pace.

- Systematic delirium is characterized by the presence of an evolving scenario, can be complicated by mental automatisms, ideational or verbal.

- Furibud delirium is characterized by a sudden anger, which flows with a strong excitement.

A separate group is a delirium with a fatal outcome, it unites any species that leads to a bad outcome.

Delirium stages

Deleted delirium, regardless of severity, has certain stages, stages of development. Simply the easier the delirium, the faster and easier the stages change and the fewer symptoms each have. This obscuration of consciousness manifests itself in stages and after the emergence of amnesia may not be.

• At the first initial stage of delirium, psychopathological manifestations become noticeable by the evening: patients are easily distracted, chatty and fussy. At the same time, their thinking is accelerated, they are correspondingly also. The person's speeches can be inconsistent, torn in the form of an easy incoherence. Mimicry is accelerating, not always thematic, the movements are very expressive, right up to theatricalization. Such people are very sensitive to irritants. They can be angry with a bright light, any unexpected sound also excites them. They are unpleasant touch, and sometimes smells. They find figurative, scenic memories from the past. Emotionally labile, unstable, mood enthusiastic, but quickly annoyed, picky and suppressed. Disorientation usually comes with a sleep disturbance. Sleep for them is impossible, sleep intermittent with nightmares, fear and anxiety. During the awakening they can not immediately understand that this is no longer a dream. In the morning they are completely weakened and often broken.

• In the second stage of illusory disorders, emotional-hypersthenic disorders build up along with psychomotor agitation, instability of attention and problematic sleep. There are visual illusions, often paraydolic. Fantastic images appear under the influence of existing ideas. The patient is captured by their viewing, but if he is distracted, they pale and disappear. In the evening, spatial disorientation intensifies. Before falling asleep appear kaleidoscopic hypnagogic hallucinations, which change each other. The intensity of dreams is increasing. The individual often wakes up and during this does not distinguish between dream and reality. In the morning the patient falls asleep deeply. In the second stage, the flickering of the symptoms is deeply expressed: in the evening and night it intensifies, and in the daytime awareness it becomes clearer, at times there are light intervals during which the patient realizes what is happening to him.

• In the third stage of true delirium, the individual loses orientation in the surrounding space, but recognizes his personality. There is a violation of the sense of time, which then lengthens, then shrinks. At night, complete insomnia, superficial sleep appears in the morning. Pareidolia change bright visual hallucinations, usually similar to scenes that are both single and multiple, discolored and colorful, static and moving, small, ordinary or huge. In addition to visual hallucinations, true delirium also produces auditory, tactile, olfactory hallucinations, intermittent imaginative delusions.

Treatment of delirium

To treat such a formidable condition, it is important to cure the underlying problem. To bring down the height of the temperature with the help of Nurofen 200 mg for the need. Antiviral drugs are shown: Tamiflu preparations, Oseltamevir, Amizon, pegylated interferons Pegasys, Pegentron, interferons, cephalosporin antibiotics Ceftriaxone, Cefodox. With tuberculosis we use Pyrazinamide, Streptomycin, Etambutol according to the scheme. At toxic effects, Naloxone antidotes are used.

It is important to carry out detoxification of the body: Rheosorbylact 300 ml IV, Trisol 500 ml IV throughout the day, Isotonic solution 500 ml, Glucose 5% 100 ml selectively according to the indications.

For the relief of symptoms, actually delirious, selective neuroleptics are selected. With vivid symptomatology, it is better to use powerful effective antipsychotic effect: Haloperidol 20-40 mg / day, Triftazin 30-80 mg / day, Stelocin 30-80 mg per day, Pimozid-Orap, Flushpiren imap, Penfluridol-Semap, Chlorprotixen. Neuroleptics - sedatives can also help to resolve the condition positively: Aminazine up to 1200 mg per day, Proparin, Tizercin up to 300 mg per day. More modern ones with reduced side effects may also come in handy: Neuleptil, Azaleptin, Sulpiride, Carbidine.

To strengthen effectiveness, tranquilizers can be used, especially in cases of impossibility of sending an individual to a psychiatric hospital: Andaxin 2-4 g, Librium 50-100 mg, Tazepam 5-10 mg 4 times a day, Nitrazepam 5-15 mg, Mebikar 0.5-1 mg 2-3 times / day, Trioxazine 1-1.5 g / day, Diazepam 15-60 mg / day, Gidazepam.