Delirium

Delirium - a mental disorder with disturbance of consciousness, true hallucinations, delirium, behavioral and emotional disorders we choice seroquel help. Orientation in self retained in place and time - partly broken. Developed for serious infectious and somatic diseases, brain trauma, poisoning, postoperative states, malignant neoplasms, withdrawal syndrome on the background of alcohol withdrawal and certain other substances. Treatment - drug therapy, rest, specific care conditions.

Delirium - psychopathological syndrome characterized by varying degrees of impaired consciousness, delirium and hallucinations true. It arises due to decompensation of brain functions on a background of metabolic disorders; It is a kind of analogue of acute hepatic, renal or cardiac failure. Is classified as transient mental disorders, in most cases, complete recovery ends. The prevalence of delirium in the average of the population - 0.4% in persons over 55 years - 1.1%.

The term "delirium" was put into use in the first century BC, a Roman scholar Aulus Cornelius Celsus. Currently, treatment of the concept has expanded considerably in the modern classifications of delirium to include not only the state, accompanied by explicit true hallucinations, and other forms of impaired consciousness, including - coma, stupor and torpor. The degree of consciousness disorders in delirium may vary significantly from individual rambling statements and transient episodes of confusion to deep disturbances to the formation of a complex system of delirium.

Three main groups of causes of delirium can be identified. The first - the state, due to somatic diseases, the second - a neurological disorder caused by disease or injury, the third - acute and chronic toxicity. The first group of reasons - serious illness of the internal organs and acute surgical pathology. In addition, impairment of consciousness often associated with infectious diseases accompanied by severe hyperthermia:.. Rheumatism, streptococcal septicemia, malaria, typhoid fever, pneumonia, etc. Transient delirious symptoms of varying severity is often observed in the postoperative period, especially at the stage of pre-hospital care and during surgery, the patient suffered from hypoxia.

The second group of reasons include viral encephalitis and meningoencephalitis, tuberculous meningitis, non-specific bacterial meningitis, subarachnoid hemorrhage, and traumatic brain injury, tumor or vascular nature. Very often delirium developed with involvement of the upper sections of the brain stem and temporal lobes of the cerebral hemispheres. The third group of causes of intoxication include certain drugs (atropine, scopolamine, caffeine, camphor, fenaminom), withdrawal syndrome in alcoholism and barbitalism.

The main pathogenetic mechanism of the disease is diffuse errors of metabolism in the brain and decompensation of cerebral functions as a result of prolonged or overly strong endogenous and exogenous factors. Delirium should be considered an unfavorable sign, testifying to serious violations in the work of various organs and systems. Typically, delirium is a transient disorder, all his symptoms are smoothed out and disappear as the normalization of the general state of the organism. In some cases, it may be fatal.

The risk group includes patients with severe injuries and diseases (including surgical pathology), patients with pre-existing cognitive impairment and persons who abuse drugs or alcohol. The likelihood of delirium increases with age. In 10-15% of elderly patients with disorders of consciousness are identified at admission, at 10-40% delirium occurs during patient treatment. Especially a lot of patients with disorders of consciousness in the intensive care units and burn centers. In AIDS patients impaired consciousness detected in 17-40% of cases, patients suffering from malignant tumors in the terminal phase - in 25-40% of cases. After surgery delirium develops in 5-75% of cases.

Start acute delirium. Developed clinical picture is preceded by a prodromal period. The first symptoms appear in the background of worsening basic physical illness, as we approach the critical point of infection, after a few hours or days after the abrupt withdrawal of alcohol. The main place in the clinical picture is occupied hallucinations, delusions, emotional and cognitive disorders, accompanied by excessive sweating, muscle weakness, changes in temperature and blood pressure, increased heart rate, unsteady gait and tremor of the limbs.

The prodromal period marked anxiety, irritability, difficulty when trying to concentrate, sleep disorders and appetite. Patients with poorly tolerated bright lights and loud noises, difficulty falling asleep, during the night of nightmares. When going to sleep often occur hypnagogic hallucinations. In the daytime, the individual scenes are possible violations of the perception of reality, manifested in the form of detachment or inappropriate remarks.

In the following disorders of consciousness are permanent, more pronounced. Notes some cyclical: day consciousness a few patients clearer, possible lucid intervals (periods of enlightenment with adequate perception of reality), in the evening and at night there has been increasing symptoms. Disorders of consciousness manifest difficulties when trying to focus and disorientation in time and place. At the same time the patient normally oriented in the self: remember your name, age, profession and marital status.

Permanent signs of delirium is an illusion and true hallucinations. Illusions - a kind of distortion of reality, an unusual perception of normal signals from the outside world. For example, in a crack in the wall of the patient sees the snake, and the sound of rain outside perceives as sounds of rebellion. Unlike illusions, hallucinations arise "from scratch", without a push from the outside and can be very complex, from the well-known "green men" to the realistic but non-existent figures, for example, another woman, who allegedly taking a bath. the patient's consciousness creatively mixes the real situation with the illusions and hallucinations, but real events and subjects the patient hardly notices.

Delirium is associated with the content of hallucinations, the degree of structuring it can vary widely, from single incoherent statements to slim psevdologichnoy system. Usually there is persecution or nonsense attitude. Emotional disturbances are determined by the content of delusions and hallucinations. The prevailing fear, sometimes - a comprehensive, accompanied by rapid breathing, trembling and muscle tension. Fear is growing with the increasing stupefaction and reaches a maximum at night. During delirium, impaired short-term memory and immediate remembering. At the same time long-term memory is almost not affected.

Delirium lasts from several days to several weeks. Indicating that there is delirium end, a calm deep sleep. Lucid intervals gradually become longer, impaired consciousness - less deep. In most cases, the outcome of a full recovery is observed, in some cases, the patient's delirium ends in death. After the release of delirium occurs partial amnesia, the memories of his experiences vague, indefinite, sketchy-like nightmares.Severity of clinical symptoms can vary considerably not only in different patients, but one patient. Sometimes they found some signs of delirium, sometimes there is a full-blown. In mild cases, delusions and hallucinations fragmentary or almost not expressed, observed only a few times a light haze of consciousness, accompanied by distraction, embarrassment contact with others and incoherent statements.