What is Delirium that is not caused by alcohol or other psychoactive substances?
The most susceptible to delirium are children with hyperthermia, traumatic shock and burns that easily stimulate the indicated disorder, as well as the elderly, any somatic pathology in which they can cause delirium.
Causes of Delirium, not caused by alcohol or other psychoactive substances
The causes of delirium are vascular disorders, for example, in hypertensive illness, overdose of medications that do not have a psychoactive effect in medium doses, in particular hormones. Causes also include infections (encephalitis, meningitis, sepsis, pneumonia), intoxication (disintegration of the tumor, burns), brain tumors, sensory deprivation as a result of limiting visual and auditory information (imprisonment), insomnia, prolonged mental stress, chronic pain, hyperthermia in children, hypothermia. The cerebral cause of delirium is overstimulation of the evolutionary ancient structures of the midbrain and stem, which can explain the fact that the syndrome is more often associated with the phases of transition from sleep to wakefulness, characterized by the frightening nature of visual hallucination, fear. Often delirium occurs when a combination of several factors, such as somatic pathology on the background of atherosclerosis of cerebral vessels. In fact, this category includes acute infectious psychosis and acute psychoorganic syndrome.
The Symptoms of Delirium, not caused by alcohol or other psychoactive substances
More often delirium is confined to the evening or early morning hours. Hallucination is often felt as a continuation of nightmares.
The onset is acute, but the syndrome is preceded by anxiety, panic, hyperacusia, and autonomic disturbances (sweating, tachycardia, nausea, tremor), sometimes a rise in temperature. The patient may be fussy or anxious to stay in bed. The state during the day flickers, the duration of intermittent episodes up to 6 months. In the classic picture of delirium – disorientation in place and time with a safe orientation in the self.
Dates are usually called from the recent past, and when coming out of delirium – from the near future. Unstable and easily switched attention. Increased suggestibility, which is tested on the basis that the patient is able to talk on the disconnected phone, read the text on a clean sheet and tie an invisible thread. Rhythm sleep disturbance – wakefulness. Visual hallucinations are frightening, often of a zooptic nature, which can be stimulated by pressure on the eyeballs. Hallucinations are preceded by illusions and paradydols, as well as visualized imagination. Behavior is determined by the content of hallucinatory images (search, attack, flight and defense, professional actions). Look confused, fixed unstable. Emotional inadequacy and instability. A terrible symptom is the appearance of robbing gestures (mussity), as well as a decrease in motor activity and muttering speech. Typically, these signs indicate the transition of delirium to amentia and to whom. Somatic disorders accompanying delirium include hyperthermia, nausea, vomiting, tachycardia, sweating, flushing or paleness of the skin, and heart rhythm disturbances. Although there is no amnesia after emerging from delirium, the patient can still fragmentarily remember its content if the delirious consciousness is transformed into a twilight or amental one. Background EEG activity is usually slowed down. Delirium may include elements of delusional perception, but they are extremely unstable and changeable. These are usually ideas of pursuit, relationships, meanings with magical symbolism.
In the acute and initial period of traumatic brain injury, delirious episodes are possible in the evening and at night, which begin with hyperesthesia, vivid representations, occur against the background of asthenia with physical inactivity, vestibular disorders, nausea. If, after a light period, these conditions recur and are accompanied by increased local headache, vomiting, yawning, chilling, lethargy and stunning, this may indicate a hematoma. Other hematoma symptoms include arterial and cerebrospinal hypertension, bradycardia, blood in the liquor, hyperemia skin of the face, “goose” skin, congestion in the fundus of the eye, Jacksonian and Kozhevnikovskie seizures, ptosis and divergent squint.]. A feature of post-traumatic delirium is also the fact that consciousness from delirious often goes to twilight, so when you exit the state often partial amnesia is noted.
A feature of delirium with symptomatic and infectious diseases is the presence of a prodrome within 2-3 days in the form of headaches, irritability, nightmares, fear, increased speech and motor activity, euphoria, instability of attention, subdepression. Further, stupor confusion (rausch) is noted, which manifests itself in the so-called minimal disorders of consciousness: impaired understanding, blurred perception (The blurred perception of behavior manifests itself in the fact that the patient squints, as if peering into the surrounding.), Weakening of memory and memory, difficulty in finding words, reduced ability to reason. Further, the symptoms of delirium, and with an increase in intoxication – amentia, stupor and coma.
Diagnosis of Delirium, not caused by alcohol or other psychoactive substances
The main diagnostic criteria for delirium are:
Changing the orientation in time and place while maintaining self orientation. Violations of perception (illusions, pareydolii, hallucinations, often visual). Psychomotor disorders associated with impaired orientation and perception. Rhythm disorder sleep – wakefulness. Emotional disorders in the form of fear and anxiety, euphoria.
Differential diagnostics
Delirium, not caused by alcohol and other psychoactive substances, has to be differentiated from intoxication delirium, acute transient psychotic disorders, acute psychosis in schizophrenia, and other states of confusion, in particular, dissociative and asthenic organic confusion.
Delirium caused by psychoactive substances proceeds against the background of withdrawal symptoms or acute intoxication, although there are also delayed delirious states. Therefore, for differential diagnostics, the intoxication history and the identification of the somatic, biochemical signs of a specific intoxication are of importance. Intoxication deliriums are distinguished by a greater degree of disturbance of consciousness, and they are also more often completed with amnestic disturbances.
Acute transient psychotic disorders are characterized by polymorphic delusions, acute sensual delusions, true auditory and pseudo-hallucinations predominate, and confusion and incoherence are caused by delusional perception, rather than qualitative disturbances of consciousness.
Organic asthenic confusion is a more short-lived condition and is not accompanied by perception disorders, although sometimes it is confused with delirious disorientation.
With dissociative disorientation, there is a noticeable difference in the patient’s behavior depending on whether they are being watched or not, and delusional statements are more like fantasies, that is, they are unstable.
Treatment of delirium not caused by alcohol or other psychoactive substances
Depends on etiology (distancing from the source of stress, vascular or metabolic causes). Older patients are avoided with benzodiazepine treatment, as they cause a deepening of consciousness disorders, therefore they apply bushpar. In middle-aged patients, the use of benzodiazepines in medium doses (seduxen, sibazon, Relanium) is necessary. Psychomotor stimulation is stopped by haloperidol in doses up to 10–20 mg or by carbamazepine in doses up to 400 mg. Symptoms of anxiety are removed by beta-blockers (atenolol, inderal, anaprilin).