Delirium is insanity, in Latinlanguage means insanity. Delirium is characterized by the confusion of consciousness with pronounced visual illusions, hallucinations and pareidolias, which are accompanied by imaginative delusions, as well as various mental disorders and psychomotor agitation. The disease is often reversible and short-lived, when the cause is identified and the right treatment is made in time.
Causes of a disease that can provoke may beset: acceptance of chemical substances (alcohol, anesthetics, drugs); drug abolition, hypoxia, sleep deprivation, somatic diseases, renal failure, CNS diseases, neoplasms, hyperthyroidism, hepatic insufficiency, hyperglycemia, as well as postoperative period and various infections.
There are three main factors,predisposing to the development of insanity - it's old age, brain damage, addiction to drugs and alcohol. There are medical observations that stable individuals are less prone to delirium.
Up to 30% of all cases of delirium begins whenthe patient begins to worry about somatic disease, and he has to stop taking alcohol. Symptoms of the disease are: vomiting, headache, speech disorders, various neurological disorders, convulsive seizures.
The first symptoms of delirium are a premonition of an approaching disaster, an unexplained anxiety, a deterioration in sleep.
The clinic of delirium is marked by somaticmanifestations: excessive sweating, trembling of the hands, increased heart rate, high blood pressure and body temperature, redness of the eyes, face. The patient's nighttime sleep worsens, dreams are heavy and nightmarish.
Before falling asleep, visualhallucinations, and in the waking state there are auditory as well as visual deceptions: the slamming of doors, steps, calls, the movement of shadows on the periphery of sight. The fourth night is accompanied by insomnia, bright and strong illusions, hallucinations in which there are insects and animals, much less often fairy-tale creatures: elves, gnomes, devils. In general, the nature of hallucinations is quite individual.
Patients are characterized by tactile hallucinations: crawling of insects, their catching, pressure. Often the sick person hears voices that do not touch him, but sometimes turn to him and give him an order, or call him a drunkard, or just teasing. The patient gradually becomes inadequate and is enveloped in hallucinations. Over time, delirium develops (persecution mania, jealousy) or an excited state and a craving for heroic deeds.
The patient has a mental conditioninstability, as the periods of excitement are replaced by calm, aggression and fear. In the first half of the day the disease subsides, recedes and the patient becomes adequate, oriented in the environment, tells what happens to him at night. However, the condition worsens by evening.
The duration of delirium reaches 3-5 days,thus the patient practically does not sleep. Then the disease recedes and the first sign of improvement is the appearance of normal sleep. The severe form of delirium results in either complete recovery or a fatal outcome. The temperature rise in the patient reaches 40 degrees, increasing dehydration of the body, as well as the nitrogen content in the blood. The patient is concerned about various vegetative disorders that can lead to a serious condition and further death. Death can come from inadequate behavior or from committing suicide in a delusional state.
The disease includes the following: alcohol delirium, infectious delirium, vascular delirium, abortive delirium. Delirium infectious occurs at the onset of an infectious disease (childhood infections, typhus, pneumonia) before the elevation of high body temperature. Infectious delirium does not always appear suddenly. Attention is drawn to the anxious behavior of the patient, as well as fussiness, throwing on the bed, changeable position of the body with moans, crying, refusal of food, unnecessary movements. Often, patients experience sensitivity to noise, as well as bright light. In the evening, all these phenomena intensify. Most patients doze or just lie with their eyes open, looking at the ceiling, walls, plunging into their experiences and reluctantly answering questions. Patients may experience pareidolia, and insomnia may develop.
The unfolded delirium stage is markedexcitement expressed at night. This manifests itself in a quick jump from the bed, rarely jumping out of the window, and also running out into the street. On his face, the expression of alarm and fear is noticeable, his eyes shine and are wide open.
A patient delirium may be screamed by somephrases, words, it seems that he communicates with someone and answers questions. When you address the patient in this state, the answer is not heard right away. The patient who is not oriented in time, and also the place correctly answers questions about his condition, and also tells about various pictures: about animals or supernatural beasts attacking them.
Delirium vascular - this is the night episodes of patientswith cerebrovascular insufficiency, provoked by micro-insults, ischemic attacks. To micro-insults carry hypertension, atherosclerosis, stroke.
Delirium abortive is a short-term,manifested unstable delusional ideas, hallucinations state without disruption of orientation, as well as amnesia. This condition lasts up to a day, not heavy, but it can precede a great delirium.
Alcohol delirium is a condition arising at the time of alcohol withdrawal, for which a literally shaky obscuration is characteristic.
Alcoholic delirium appears in the II-III stagealcoholism, as well as in the period of stopping drunkenness. It is characterized by delirium, hallucinations, chills, fever. Hallucinations represent a threatening character and appear before a person in the form of dangerous, small creatures (devils, insects). Forecasts are favorable, often recovery occurs. Danger is self-harm.
A characteristic feature is thatAlcohol delirium rarely develops after intoxication. Often its development comes on the fifth day after the abolition of alcohol and five years after the systematic use of alcohol. The disease affects people suffering from chronic alcoholism of II-III stage, and after a long drinking-bout and after its termination. Persons who do not suffer from chronic alcoholism are less likely to be sick. The risk group includes those who have undergone serious CNS diseases, as well as craniocerebral injuries. Patients who in the past suffered
it is possible to repeat alcohol delirium after taking alcoholic beverages.
Delirium alcohol treatment
The disease needs to monitor the patient, ensure safety, and also requires intensive drug therapy. If necessary, resuscitation should be carried out.
Delirium alcohol is treated at the basepsychoneurological hospital with the participation of a therapist and resuscitator. There are many drugs, but there is no consensus on the algorithm for treating this condition. Europe adheres to the treatment of Clomethiazole. Russia and the USA use benzodiazepines. Side effects from them are respiratory depression, cumulation of sedation. Most cases in the treatment of alcoholic delirium are reduced to intravenous combination therapy with haloperidol or benzodiazepines. Simultaneously with the relief of mental symptoms in treatment, all intensive measures that eliminate somatic disorders are used. Using all these drugs, their degree of influence on the nervous system should be taken into account.
Treatment of delirium involves hospitalization inpsychiatric hospital. To stop the excitation, use a solution of Sibazon, Sodium Oxybutyrate. Metabolic disorders are eliminated by the restoration of the water-electrolyte balance. To do this, use sodium hydrogen carbonate, Reopoliglyukin, Panangin, vitamins (B1, C, B6, PP). In the hospital, the patient will recover breathing, eliminate hemodynamic disorders, reduce hyperthermia, eliminate impaired renal function, and also liver. Mannit will eliminate pulmonary edema, as well as the brain.
In severe delirium, a violation is observedblood circulation in small vessels and shows the introduction of intramuscularly or subcutaneously necessary medicines in such cases. For a more rapid therapeutic effect, the drug should be administered predominantly intravenously.