The term “delirious” (from the Latin “deviating from a straight line”) conjures up the image of someone who is wild and out of control. This is extremely misleading. Although some people with Delirium do become temporarily agitated and difficult to contain, there are many others who develop confusion and disorientation in a quiet, unobtrusive way that will be missed unless Delirium is considered as a possible reason for their changed behavior.
The experience of Delirium is like being in a fuzzy dream or a dense fog that is clouding your awareness of the outside world. You lose the ability to keep track of what is going on and feel frightened, agitated, or even combative. You may become disoriented and feel confused as to where you are, the time of day, the season of the year, who the people are around you, or even (at the extreme) who you are. Delirium is usually a short-term problem that arises suddenly. Within days, it either disappears completely with no permanent damage or more tragically may be a precursor to irreversible Dementia, Amnestic Disorder, or even death. Delirium is one of the few problems for which prompt diagnosis and treatment is a medical, not just a psychiatric, emergency.
According to the diagnostic manual, you have Delirium if :
- Your awareness of the external environment has been seriously compromised —you are unable to pay attention to or keep up with what’s going on around you.
- You have at least one additional and serious problem in the way your mind is working. These include:
(1) You are disoriented—you do not know where you are, what day it is, or who other people are around you.
(2) You are having hallucinations—you see, hear, feel, smell things that are not really there.
(3) You have serious problems remembering things like what happened earlier that day.
(4) Other people have trouble following your speech because it is rambling or disorganized.
- Your symptoms have started up abruptly and fluctuate during the day.
Virtually all brain functions become disturbed during Delirium. Recent memory is almost always affected. Who visited earlier that day, what was served for breakfast, what the doctor said during morning rounds (or five minutes ago) all fade away quickly in a cloud of confusion. It is difficult to communicate. The person’s attention keeps wandering to the other things that are going on in the room, the distractions of TV or radio, or someone walking by. You probably will have to repeat your questions over and over again. The person has trouble understanding and responding to you, and may keep saying the same thing over and over again.
Disorientation and confusion can result in accidental injuries, tearing out intravenous lines, falling out of bed or down the stairs, or running in front of traffic. Hallucinatory experiences with accusing voices, frightening visions, unpleasant smells or tastes, and touch sensations like bugs crawling are much more common in Delirium than in Schizophrenia or Mood Disorder. Hallucinations are particularly common in people who have hearing or visual impairments.
One tip that sensory deprivation is a problem is that the patient is screaming at the top of his lungs—a hearing aid may make all the difference. In Delirium, the daily rhythm of sleep and wakefulness often becomes mixed up—the person is likely to keep drifting off during the day, but to become hyper-alert even to the point of agitation in the dead of night. This characteristic sleep-wake pattern is called “sundowning” since the trouble usually begins as evening progresses.
One of the striking things about Delirium is how abruptly it starts and ends and how much the cloudiness can fluctuate over brief periods of time. The person may slip from tranquil restfulness to confused agitation in just a matter of minutes. Sometimes, during the course of a conversation the person’s level of consciousness can switch in front of your eyes. Mood can also be surprisingly labile—apathetic or depressed one minute, angry, terrified, agitated, or paranoid the next.