What is Delirium?

It's quite possible that some of the craziest people you might ever encounter don't even have a mental illness.

I dislike the word "crazy" because it has no standard or official meaning in psychiatry, but I used it here to get your attention, because the point I want to make is very important--becoming familiar with this subject might enable you to save a life some day.

Behaviors strange and sudden

To rephrase that first sentence above: When you see someone go very abruptly from being relatively sane to

• having wild mood swings
• acting agitated and disorientated
• talking about bizarre and invisible things
• becoming obviously paranoid and hallucinatory

then we can all agree that that person's mental capacities are deeply disturbed. But.

But…a big and abrupt mental shift like this is almost certainly not a mental illness, in the sense that schizophrenia and bipolar disorder are. Schizophrenia and bipolar disorder, you see, are illnesses that are rooted wholly in the mind--and in nothing but the mind. The sudden-onset illness described above, on the other hand, is likely delirium, which is an illness not only of the mind but also of the body.

A lifesaving tidbit of knowledge

Becoming familiar with the characteristics of delirium might allow you to someday save the life of a loved one. Here's why: When a previously mentally stable person suffers an abrupt change in mental state--especially if the person is middle aged or older and is in questionable physical health--then you should automatically assume that the diagnosis is delirium until proven otherwise.

What are the causes?

Delirium occurs when the body has a disease that causes the brain to be either

• deprived of nutrients, or
• flooded with toxins, or
• distorted by a bad reaction to medications.

Who knew?

It's amazing, and a bit disheartening, how few folks--even my fellow medical doctors--really know anything about delirium and its symptoms.

I say this because, when friends and relatives seek me out for free psychiatric advice, the problem I most often hear them describe is delirium: how someone was having or had just had an episode of illness; how this person suddenly became very agitated and confused; how the doctor then gave the patient a new drug(s) to calm the agitation; and how the patient is now acting more confused and "crazier" than ever.

Even doctors can be fooled

Most doctors, if they are told that a patient suddenly became confused after being given new drugs X, Y, and Z, will usually be able to recognize the likely connection with delirium.

But these same doctors will often misdiagnose delirium if the patient's mental state becomes seriously altered without an obvious cause. Why? Because technology has changed the way doctors think, and not all for the better. In the old days, when laboratory tests were new and few, doctors used them to confirm or rule out the disease they thought the patient had, based on their examination of the patient. Now, the reasoning goes the opposite way--the "hyper" this or "hypo" that in the blood test, the spot on the MRI scan, and so on, is the diagnosis. And so, by this reasoning, the absence of a laboratory abnormality is assumed to signify that the disorder is somehow not real; it must be "psychiatric."

What you see is what you get

Because the only clues delirium gives as to its identity are the actual signs and symptoms it causes in the patient, delirium is an illness that can only be given a "clinical" diagnosis. That is, the diagnosis of delirium can be made--often must be made--without knowing its cause. So the whole point with delirium is to find what's causing it--and to keep looking for a cause until you've found it.

It can even be fatal

While it's true that delirium doesn't kill anyone directly, a very high rate of death is associated with it because of the kinds of physical conditions that can cause it--sepsis (a generalized state of infection), kidney or liver failure, a lack of oxygen supply to the brain due to anemia or respiratory or cardiac insufficiency. Diseases such as these can often put people in mortal danger, but the only indication of trouble is often a peculiar agitated mental state. Here, the mind is like a canary in the coal mine--it's often the first thing to really go haywire when the body starts to fail.

Therefore, if you're ever caring for someone who is sick or elderly and they suddenly start losing their mind, make sure that the doctor first considers a diagnosis of delirium before he or she starts giving them meds for the treatment of bipolar disorder, or depression, or "late-onset schizophrenia."