SHRINKS THINK

TOPIC: DELIRIUM

Why do I share what Shrinks Think?  Stigma, a major problem in people getting the help needed to live good lives, is reduced  the more we understand   mental illness.  Increasing  our knowledge of what it feels like to be caught in one or another symptom builds another aspect of our understand. Not that one person every really knows  what another person feels.

We have all had moments of delirium.  We have also seen others caught in the arms of this particular mental illness, it is scary.

I was often visited by the Fever People as a child.  They were infection induced delirium and  hallucinations.  When I tried pot, I had paranoid delusions.  Kept me from smoking pot. Those are common states of mental confusion–the easiest definition of delirium. The nearest most of us get to a true delusional state is in our dreams.  Happy dreams often duplicate the thrill and good feelings that can accompany delirium, while our  nightmares capture the down side. My nightmares are as close as I want to get to the major symptoms of any major mental illness.

Definition of delirium from the on-line dictionary.

1. A temporary state of mental confusion and fluctuating consciousness resulting from high fever, intoxication, shock, or other causes. It is characterized by anxiety, disorientation, hallucinations, delusions, and incoherent speech.
2. A state of uncontrolled excitement or emotion: sports fans in delirium after their team’s victory.

A QUOTE TO THINK ABOUT

Why it is important to recognize and systematically screen for delirium:

  • Common condition (20-30% in general medical setting, as high as 80% in ICU setting)
  • Increased mortality (6-month mortality as high as 25%)
  • Increased morbidity (higher risk of anxiety, PTSD)
  • Increased costs (increased length of stay, increased readmission rates, increased nursing home transfers)
  • Distress for families (lower quality of life, more anxiety, greater burden of decision-making)

The quote came from one of my favorite Shrink Thinks bloggers.  Here is the article I took it from.

Delirium: The Great Pretender « The Practical Psychosomaticist: James Amos, M.D

For those not into reading long articles, here are the symptoms as noted in the Diagnostic and Statistical Manual (DSM-IV-TR):

  • Disturbance of consciousness with reduced ability to focus, sustain, or shift attention.
  • Change in cognition (i.e., memory deficit, disorientation, language disturbance) or perceptual disturbance not accounted for by preexisting, established, or evolving dementia.
  • Disturbance develops over short period of time and tends to fluctuate over course of day
  • Evidence from history, physical exam, or laboratory findings that disturbance caused by direct physiological consequences of general medical condition

Mnemonic quoted in the article. It details the causes and is a reminder that when you see disorganized, confused thinking these might be the cause:

“I WATCH DEATH”

  • Infection/Inflammation/Iatrogenic (rheumatologic, constipation)
  • Withdrawal states
  • Acute metabolic derangements (hypomagnesemia, hypercalcemia)
  • Trauma
  • Central nervous system pathology (stroke, hemorrhage, tumor, seizures, infection)
  • Hypoxia
  • Deficiencies (thiamine, B12, folate)
  • Endocrine (hypoglycemia, diabetic ketoacidosis, thyroid, adrenal, parathyroid disease)
  • Acute myocardial infarction or vascular events
  • Toxins or drugs (anticholinergics, sedatives, steroids)
  • Heavy metals (arsenic, lead, mercury)

STAYING STRONG TIPS

First tip: Note that Delirium is mostly caused by medical conditions.  Anyone can fall victim.

Second tip: Often the changes in behavior brought about  the medical conditions are not considered as creating the delirium.  Which then leads to greater stigmatization.  Better to be physically ill than mentally ill.

Third tip: Understand that great divide.  The talk therapists and the medicating therapists are often on the opposite side of the nature/nurture divide.  So is the general public.  The nurture people mostly see the problem as a response to life experiences, mostly bad parenting.  The nature people mostly see the problem as a brain based chemical disorder cause by trauma or genes.  Sadly this either/or approach is less effective than a yes/and approach.

Fourth tip:  When you seek psychiatric help, whether you are seeing a nature or a nurture type, try to find one who has a foot on each side.

Fifth  tip:  The earlier competent help is sought for major mental illness, the better the outcomes.  How do you know someone is competent?  Not because your friends say so.  Ask about use of outcome studies.  And that my friends is the next blog post.  Seems like the topic of the week is  Shrinks Think.

Final tip: Do not practice medicine without a licence on yourself, your friends, your enemies, your family, your lovers.  Seek professional advice if disturbing patterns of behavior on your part or another person’s part diminish your ability to enjoy the good life.

FOR MORE  SHRINKS THINK Posts click here.

AS ALWAYS PRACTICE KINDNESS

Be kind to  me,  like this post or share it.  You will be helping me stay strong and maybe some others as well.  You will also be practicing one of the 12 Daily Emoitonal Fitness Exercises.  Click here for my free E-book: The 12 Daily Emotional Fitness Training.

A FINAL WORD

The 12 Daily Exercises are for everyone, but if you are seeing a therapist share them.  If  regular practice of the 12 Daily does not improve  the quality of your life, more might be needed.  That is the time to think about therapy.

Katherine

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