Delirium
About this leaflet
You may find this leaflet helpful if:
- you have experienced delirium
- you know someone with delirium
- you are looking after someone with delirium.
What is delirium?
Delirium is a state of mental confusion that
can happen if you become medically unwell. It is also known
as an 'acute confusional state'.
Medical problems, surgery and medications can
all cause delirium. It often starts suddenly and usually lifts
when the condition causing it gets better. It can be frightening –
not only for the person who is unwell, but also for those around
him or her.
What is it like to have delirium?
You may:
- Be less aware of what is going on
around you.
- Be unsure about where you are or what
you are doing there.
- Be unable to follow a conversation or
to speak clearly.
- Have vivid dreams, which are often
frightening and may carry on when you wake up.
- Hear noises or voices when there is
nothing or no one to cause them.
- See people or things which aren’t
there.
- Worry that other people are trying to
harm you.
- Be very agitated or restless, unable
to sit still and wandering about.
- Be very slow or sleepy.
- Sleep during the day, but wake up at
night
- Have moods that change
quickly. You can be frightened, anxious, depressed or
irritable.
- Be more confused at some times than at
others – often in the evening or at night.
How can I help someone with delirium?
You can help someone with delirium feel calmer
and more in control if you:
- Stay calm.
- Talk to them in short, simple sentences. Check that they have
understood you. Repeat things if necessary.
- Remind them of what is happening and how they are doing.
- Remind them of the time and date. Make sure they can see a
clock or a calendar.
- Listen to them and reassure them.
- Make sure they have their glasses and hearing aid.
- Help them to eat and drink.
- Try to make sure that someone they know well is with them. This
is often most important during the evening, when confusion often
gets worse.
- If they are in hospital, bring in some familiar objects from
home.
- Have a light on at night so that they can see where they are if
they wake up.
How common is it?
- About 2 in 10 hospital patients have a period of
delirium.
- Delirium is more common in people who:
- are older
-
have memory problems
-
have poor hearing or eyesight
-
have recently had surgery
-
have a terminal illness
-
have an illness of the brain, such as an
infection, a stroke or a head injury.
Why does it happen?
The most common causes of delirium are:
- a urine or chest infection
- having a high temperature
- side-effects of medicine like pain killers and
steroids
- dehydration, low salt levels, low haemoglobin (anaemia)
- liver or kidney problems
- suddenly stopping drugs or alcohol
- major surgery
- epilepsy
- brain injury or infection
- terminal illness
- constipation
- being in an unfamiliar place.
There is often more than one cause – and sometimes the cause is
not found.
How is delirium treated?
If someone suddenly becomes confused, they
need to see a doctor urgently. The person with delirium may be too
confused to describe what has happened to them, so it's important
that the doctor can talk to someone who knows the patient well.
To treat delirium, you need to treat the
cause. For example, an infection may be treated with
antibiotics.
Can sedative medication (tranquillisers) help?
Sedatives can make delirium worse, so should
only be used in a few situations:
- When someone who drinks a lot of alcohol stops suddenly, they
will need a regular dose of a sedative medication (benzodiazepines)
that is reduced over several days. This will stop withdrawal
symptoms, but should be done under close medical supervision.
- To calm someone enough to have investigations or
treatment.
- To stop someone endangering themselves or other people.
- When someone is very agitated or anxious.
- When someone is seeing or hearing things that are not
there.
Low doses of antipsychotic medication should be given to help
with frightening hallucinations or beliefs that people are trying
to harm you.
Any sedative medication should be given in the lowest possible
dose for the shortest time possible.
How long does it take to get better?
Delirium gets better when the cause is
treated. You can recover very quickly, but it can take
several days or weeks. People with dementia can take a
particularly long time to get over delirium.
How do you feel afterwards?
You may not remember what has happened,
particularly if you had memory problems beforehand. However,
you may be left with unpleasant and frightening memories – and even
worry that you are going mad.
It can be helpful to sit down with someone who
can explain what happened.This might be a family member, a carer or
your doctor. They can go through a diary of what happened each
day.
Most people feel relieved when they understand
what happened and why.
Will it happen again?
You are more likely to have delirium again if
you become medically unwell. Someone needs to keep an eye out
for the warning signs that you are getting unwell again – whatever
the original cause was. If they are worried they should get a
doctor as soon as possible. If medical problems are treated early,
this can prevent delirium from happening again.
Prevent delirium video
The delirium awareness video, I can prevent
delirium, was produced by Faculty of Old Age
Psychiatry members, Dr Krishnan and Dr Bennett, in
collaboration with Teesside local councils and CCG to
improve awareness of delirium as part of
#icanpreventdelirium campaign and conference.
References
- NICE Guidelines CG103 (2010).
Delirium:diagnosis, prevention and management
- Clinical management and prevention of
delirium. Marcantonio ER. Psychiatry (2008);7:
42-48.
- Delirium. Brown B & Boyle M.
In: ABC of Psychological Medicine (2003). BMJ Books.
- Drug treatment of delirium: Past, present and
future. Bourne RS et al. Journal of Psychosomatic
Research (2008);65:273-282.
- The delirium experience: a review.
O’Malley G et al. Journal of Psychosomatic Research
(2008);65:223-228.
Further information
European
Delirium Association
An organisation for health professionals and
scientists involved with delirium. The website also has links
to other websites that have information on delirium for health
professionals, patients and carers.
Royal College of
Physicians
The prevention, diagnosis and management of
delirium in older people - national guidelines. Royal College
of Physicians. 2006. Guidelines for health
professionals working with people with delirium.
Royal College of
Psychiatrists
People with dementia are more likely to also
have delirium. Further information can be found in the Help
is at Hand Leaflet on “Memory
problems, alzheimer's and dementia."
This factsheet was produced by the RCPsych's Public Education
Editorial Board.
Series Editor: Dr Philip Timms.
Original authors: Dr Hilary Gordon, Professor George Ikkos ,
Dr Susie Lingwood and Dr Jim Bolton.
© Updated October 2015. Due for review: October
2018. Royal College of Psychiatrists.
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