Do you know acute confusion syndrome or delirium?Is it a neurocognitive disorder that affects 1 to 2% of the general population (14% of people over 85), has as its fundamental characteristic a change of consciousness accompanied by a decrease in attention span and other cognitive changes that affect memory, language, perception?It is an acute disease that usually lasts from hours to several days.
As we will see, delirium can be caused by multiple aetiologies, although they all have an organic origin (ingest certain medications, diseases, poisoning or substance withdrawal?).
- It is an image of pathogenic identity; that is.
- The condition (symptomatology) is similar.
- Regardless of its cause.
In the past, a manifestation associated with what we now call acute delirium or delirium was already recognized. Specifically, this syndrome was originally described by Hippocrates and the term delirium first appeared in documents written by Celsus in the 1st century BC.
In 1813, Thomas Sutton described a more specific clinical syndrome, delirium tremens, related to regular alcohol consumption; Subsequently, Emil Kraepelin proposed the existence of specific mental syndromes for each somatic disorder.
A little later, in 1910, Bonhoeffer described five syndrosomal groups or clinical varieties that had appeared acutely during various diseases. These groups were: delirium, epileptic arousal, twilight state, hallucinosis and mental weakness.
Delirium has a prevalence of 1 to 2% in the general population, according to DSM-5 (2013), which increases with age and reaches 14% in people over 85, and also affects 10-30% of hospitalized people. patients and men are a risk factor in the elderly.
DSM-5 (Diagnostic and Statistical Manual of Mental Disorders) classifies acute confusion syndrome as neurocognitive disorders (NTCs). Delirium can be caused by several causes, so DSM-5 differentiates the following types of delirium:
In addition, the DSM-5 includes the following specifications in each case of delirium: in terms of evolution, it can be acute (lasts hours or days) or persistent (lasts weeks or months). As for the level of activity, delirium can be hyperactive, hypoactive or mixed. These specifications shall be in addition to the diagnosis of the delirium concerned.
Delirium is related to confusion, as the predominant symptom is a change in the level of consciousness; it has also been related to sleep, as the delusional patient often verbalizes imaginary content similar to those of dreams, interspersing these with lucid moments. are a sudden start and a sharp course.
Let’s look at what each subtype of delirium proposed in dsm-5 consists of, according to its etiology:
The DSM-5 and its previous edition (DSM-IV-TR) and ICD-10 (International Classification of Diseases, WHO) list a number of diagnostic criteria for acute delirium. The criteria are similar in the different manuals, even if we keep the most current one (DSM-5).
The first criterion refers to a change of consciousness with decreased ability to concentrate, maintain or direct attention (this would be the central symptom), in addition the change occurs in a short time and tends to fluctuate throughout the day.
On the other hand, there is a change in cognitive functions (memory, orientation, language, visuospatial skills and perception). Another essential feature of delirium is the fact that it is always due to an organic cause and, in addition, symptoms cannot be better explained by another neurocognitive disorder (it also does not occur in situations of significantly reduced arousal).
According to the above, according to ID-10, confusion syndrome or delirium has the following characteristics:
Common features of acute confusion syndrome include
The treatment of acute confusion syndrome or delirium consists fundamentally in solving the cause that caused the disease, so the intervention will help us to quickly reverse the disorder, avoiding the worsening of the pathology.
On the other hand, complications caused by delirium can be avoided through a number of preventive interventions, in addition, there are general measures that will allow a better situation for the patient, including: preventing the onset of delirium in patients with risk factors (avoiding changes in the environment for the elderly for example) and preventing the onset of complications (accidents, infections , etc. ).