What is Delirium?
Delirium is a severe and often sudden change in mental abilities that results in confused thinking and reduced awareness of one's surroundings. It is characterised by disturbances in consciousness, attention, perception, reasoning, memory, emotionality, the sleep-wake cycle, and psychomotor symptoms [1, 2]. It is also referred to as an acute brain disorder or acute brain dysfunction [3].
Causes of Delirium
Delirium is a manifestation of stress on the function of the central nervous system in a vulnerable patient. It can be caused by a wide range of factors, often involving anything that stresses the baseline homeostasis of a vulnerable patient [4, 5].
Medication side effects: One of the major causes of delirium is medication side effects. Certain medications, such as sedatives, blood pressure medications, sleeping pills, and pain relievers, can cause delirium. Up to 39% of the time, delirium is caused by medications [6].
Common causes: Other common causes include acute illness, infections, worsening symptoms of a long-term (chronic) disease, lack of oxygen, blocked arteries, severe pain, dehydration, sleep deprivation, metabolic issues, alcohol withdrawal, and surgery or general anaesthesia [6, 7].
Effects of Medical conditions: Delirium can also be caused by certain medical conditions such as a stroke, heart attack, worsening lung or liver disease, or an injury from a fall. It can also be triggered by an imbalance in the body, such as low sodium or low calcium, severe, long-lasting illness, fever and a new infection, exposure to a toxin, poor nutrition, or a loss of too much body fluid [7].
What is encephalopathy?
Encephalopathy is a term that describes a disease affecting the function or structure of your brain. It presents a wide range of neurological or psychiatric symptoms, from subtle changes to severe conditions like coma. The condition can be temporary or permanent, and some types are present from birth and never change, while others are acquired after birth and may get progressively worse [8, 9, 10].
Causes of Encephalopathy
The causes of encephalopathy are diverse and can be grouped into primary neurologic and systemic conditions. They can also be categorized by their pace of onset and evolution, such as sudden, acute, subacute, or chronic [9].
Trauma: One type of encephalopathy, known as traumatic encephalopathy, occurs due to multiple traumas or injuries to the brain, leading to nerve damage. This is often found in individuals who have experienced repeated blows to the head, such as boxers, football players, or members of the military who have been injured in explosions [9].
Genetic condition: Glycine encephalopathy is a genetic condition characterized by abnormally high levels of glycine, an amino acid, in the brain. Symptoms usually appear in infants soon after birth [9].
Liver disease: Hepatic encephalopathy is caused when the liver isn't working correctly; it can't filter out toxins effectively, allowing them to accumulate in the blood and eventually affect the brain. [11, 9].
High blood pressure: Hypertensive encephalopathy is caused by severely high blood pressure that goes untreated for too long, leading to brain swelling and damage [12, 9].
Kidney Failure: Uremic encephalopathy results from kidney failure, believed to be caused by the buildup of uremic toxins in the blood [13, 9].
Toxic-metabolic encephalopathy: This is a result of infections, toxins, or organ failure. When the electrolytes, hormones, or other chemicals in the body are off their average balance, they can impact the brain's function [9].
Prions: Transmissible spongiform encephalopathies, or prion diseases, are caused by abnormal proteins called prions. These prions gradually damage and break down brain tissue, leading to severe neurological decline over time. [9].
Vitamin deficiency: Lastly, Wernicke's encephalopathy is a result of vitamin B-1 deficiency, often caused by long-term alcoholism, poor nutritional intake, and poor food absorption [9].
Treatment for Delirium
Non-Pharmacological Interventions
Non-pharmacological interventions are the cornerstone of delirium management. These include creating a calm and familiar environment, reducing environmental disturbances, and increasing reorientation interventions.
It's beneficial to have familiar objects present, such as family photos, and to correct sleep-wake disturbances. Visual and auditory impairments should also be addressed. Family members can have a calming effect and provide frequent reorientation, so their presence is encouraged whenever possible [14, 4, 6].
Pharmacological Interventions
When non-pharmacological Treatments are not enough, pharmacological agents may be used. Antipsychotics like haloperidol, quetiapine, and risperidone are commonly used as first-line treatments to manage disruptive or dangerous behaviours and symptoms of psychosis.
Conclusion
In conclusion, treating delirium requires a personalized, multifaceted approach that combines non-pharmacological and pharmacological methods. The main priority is to identify and address the underlying cause of the delirium. Family involvement and a calm, familiar environment can significantly aid the patient's recovery. [14, 4, 6].
Treatment for Encephalopathy
The treatment for encephalopathy varies depending on the underlying cause and can include medications, surgery, nutritional supplements, or a special diet [9].
Treating Hepatic encephalopathy: In cases of hepatic encephalopathy, treatment often involves identifying and treating the precipitating factors, reducing the formation and absorption of intestinal nitrogenous compounds, and dietary restriction. Medications such as lactulose, rifaximin, and neomycin are commonly used to decrease the production and absorption of ammonia in the gut [15, 16, 17, 11, 18].
Treating Leas Encephalopathy: In treating lead encephalopathy, the primary goals are to reduce pressure in the brain, help the body get rid of lead through increased urine output, and prevent or control seizures. To lower brain pressure, doctors may use medications like mannitol or saline. Most patients also need a breathing tube and ventilator support [19].
Treating Von Economo Encephalopathy: In the case of Von Economo Encephalopathy, treatment is supportive and can include methylprednisolone, benzodiazepines, and dopamine agonists. Electroconvulsive therapy may also be used in treatment-resistant instances [20].
Treating HIV encephalopathy: Treatment for HIV encephalopathy includes antiretroviral therapy to reduce the viral load and improve dementia symptoms. Additional medications, like antidepressants, antipsychotics, or stimulants, may be used to manage specific symptoms, such as depression, psychosis, and lethargy. [21].
Other cases: In some cases, such as Reye's syndrome, treatment requires accurate, early diagnosis, prevention of anoxia, restitution of body glycogen stores through the administration of glucose, control of the complicating cerebral oedema, and avoidance of counterproductive treatment measures [22].
In some cases, non-traditional treatments and procedural therapies such as albumin dialysis, shunt closure, and liver transplant may be considered. However, more high-quality studies are needed to routinely recommend many of these agents [23].