If you have suffered a delirious episode you may have a number of unanswered questions concerning what exactly happened, how it happened and whether it could happen again. Hopefully your doctor or psychiatrist will have helped by providing you with some detail and clarity on these questions. You may have lingering concerns about your mental health vulnerability and particularly to psychological triggers in the future. The following information may help to address some of those concerns.
It is advisable to consult with a medically qualified doctor if you are unsure about whether you have experienced an episode of delirium or are worried about a loved one. The information on this page is aimed at people who have been treated for delirium and are in the process of recovery. If you have any doubts about your own particular situation or are unsure about your course of action it is recommended that you contact your family doctor in order to assess your options.
What is delirium?
Delirium is a complex neuropsychiatric disorder and can be a very frightening experience for anyone affected, whether that is for the person who becomes unwell or for family and friends of the sufferer. It is often a sudden onset, usually occurring over hours or days, with symptom fluctuations over the course of a day.
Delirium is derived from latin meaning “off the track” and “out of the furrow”. It might also be called ‘acute confusional state’ or ‘organic brain syndrome’. It is characterised by confusion (disorientation), other cognitive impairment (attention and memory), perceptual disturbances (e.g visual hallucinations) and circadian rhythm disturbances (insomnia, sleep-wake schedule reversal). Typically symptoms are worse at night.
What causes delirium?
The cause, set of causes, or manner of causation of delirium can be broadly divided into predisposing and precipitating factors.
Predisposing factors for delirium:
- Admission to ICU. (According to the Royal College of Psychiatrists about 2 in 10 hospital patients have a period of delirium. It also occurs in post operative wards, palliative care units and in geriatric settings).
- Age over 65 years.
- Poorly controlled pain.
- History of alcohol abuse.
Precipitating factors for delirium:
- Prescribed medication.
- Abuse of illicit substances. Commonly implicated drugs are opioid analgesics, benzodiazepines, antiparkinsonian drugs and steroids.
- Withdrawal from substances alcohol (delirium tremens).
- Acute vitamin deficiency.
- Medical conditions (pneumonia UTI, meningitis high fever, metabolic disturbances, Endocrine (thyroid storm).
Are there different types of delirium?
Yes, there are generally considered to be three different types namely hyperactive, hypoactive and mixed. Outlined below is a brief description of each type.
- Hyperactive delirium: This state typically involves agitation, restlessness and could involve aggression. It can involve rapid mood changes or hallucinations and can also involve patients refusing to cooperate with care.
- Hypoactive delirium: People who suffer from this type can often be misdiagnosed as there is typically a presentation of retardation, being withdrawn and sleepy. It can often be seen as depression. This type can have the worst prognosis, as the idiom goes that the squeaky wheel (the hyperactive one) gets the oil.
- Mixed delirium: This is when an individual can fluctuate between the two types during the same period episode.
If you have suffered a delirious episode you may not remember the detail of your experiences, particularly if you suffered from memory problems beforehand. If you do remember what happened you may be left with bad memories as well as confusion surrounding the specific events. Any confusion could be compounded by loved ones not wanting to discuss it with you. It is important to remember that it can be a scary time also for those close to you who may just want you to forget the experience and not to discuss it again. Loved ones, after all, may have had extreme worry when you were unwell and the topic may not be easy for them.
It is very possible that you may have ongoing anxiety about your sanity. You will likely have had some contact with psychiatric services in a hospital or with outpatient psychiatric services. If so, your doctor or psychiatrist will be well placed to answer your questions and to discuss with you any risk factors going forward. A word of caution, however, is that psychiatric services can often be highly stretched and the amount of time you receive may be very limited.
How can psychotherapy help?
Counselling and psychotherapy can offer a private and confidential space to explore how you felt following the delirium episode. The benefits of speaking to a therapist are that you can make sense about what happened and how the experience has impacted on your life. Discussing a diary of events can help to provide clarity and address any lingering confusion. The therapy could involve creative interventions such as making use of images from your experiences. Further clarity could be achieved from discussing the meaning of such drawings or symbols which may have seemed odd or strange at the time. The imagery could be quite useful in exploring unconscious material. A delirious event can be viewed like a tyranny of consciousness where paranoia and fear can be extreme. However, some of the fears and anxieties could potentially be viewed as opportunities to reassess aspects of your psyche that might need attention. It could be that the event, however scary and unpleasant at the time, helps to bring about new insights and greater clarity to your life choices. Learning to identify risk factors as well as boosting self-care and social support could be useful outcome measures of therapy.
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