What is the difference between different types of delirium

As you know, delirium refers to a mental disorder that occurs under the influence of a large number of causes. They can be divided into two groups - exogenous and endogenous.

For exogenous reasons, all external factors that contribute to brain damage and lead to a change in consciousness and perception of the world are attributed. It, first of all alcohol, drugs, toxic substances and poisons. This includes viral and microbial intoxication, craniocerebral trauma.

Endogenous, i.e.internal, factors are usually associated with disruption of the internal organs and various body systems. Among this large group there are a number of genetic abnormalities accompanied by psychic abnormalities, hereditary diseases.

Delirium usually proceeds in mild and moderate form, but in some cases it acquires severe current and threatens the life of the patient. While in a delirious state, the patient has complicated hallucinations, they can be true when real people and objects are involved in the process of fantasy, and the inclusion of unreal objects into the illusion, while perceiving them as really existing.

Patients often have audible, visual, tactile, motorized hallucinations, they often exacerbate the picture of delirium and cause additional suffering to the patient. Emotional state with different types of this violation may be different, but largely depends on the nature of the illusion.

Often in this pathology, intellect, memory, and thinking are disturbed. And although all these conditions under the influence of treatment pass, they permanently leave a trace in the health of the patient.

After the release of their delirium, for some time there may be some inhibition, however, all the memories of the events occurring in the altered state are almost completely erased from memory.

What are the types of delirium

The clinical manifestations of delirium are very diverse and it is sometimes difficult to distinguish one species from another.

Qualitative changes:

• actual delirium;
• complete disorientation in space and self, at night can go into a delirious state - amenity;
• is a one-state condition - a complex distortion of perception, in which disorientation occurs in space and in one's own personality, and there are fantastic visions in which the patient himself becomes a direct participant.

Types of delirium are also different in quantitative disorders:

1. stunning - a kind of disturbed consciousness, in which there is a strong inhibition of reactions to external stimuli, drowsiness develops, weak orientation in the surrounding space. After exiting the state, there may be a loss of memory for the events that occurred. In case of unfavorable development the symptoms are aggravated, and a sopor or coma develops;
2. sopor - predkomatoznoe state, in which a person covers stupor, there is a deeper violation of consciousness - there is practically no reaction to surrounding people and events, the patient does not answer questions, does not react to physical effects;
3. coma is an extremely difficult condition of oppression of consciousness, in which there is completely no reaction to any stimuli. At the organ level, there are disorders of breathing, blood circulation, urination, etc. Without connecting to the device, artificial respiration and circulation, such patients die.

In practice, delirium is divided into several types:

• alcohol;
• narcotic;
• is infectious;
• is hysterical;
• is traumatic;
• postoperative;
• senile( against the background of dementia);
• professional;
• schizophrenic.

All phenomena of delirium are temporary, they only reflect the depth of the central nervous system, the degree of disturbances in metabolism. In some cases, delirium is the body's signal system, which indicates that the body has already exhausted its resources and can no longer cope with the toxic effects of exogenous or endogenous factors.

Clinical manifestations of some types of delirium

To begin with, you should specify the changes in the state common to all types of delirium:

• excited state, anxiety, fear of death, motor and speech excitement;
• the inability to sit in one place, the constant desire to occupy a new position;
• gradually exacerbating change in spatial and personal orientation;
• change in the rate of speech and its intelligibility, at later stages, patients stop contacting and responding to stimuli;
• the perception of the surrounding reality is disturbed, extremely complex, full of true and false hallucinations of auditory, tactile, visual, motor character can be present.

There are also strong changes on the part of the internal organs. So, the processes of urination are broken, oliguria can develop( small urination), there is a spasm of the vessels, to which the body reacts with sweating, increased pressure, tachycardia, weakness, may be wave-like fever.

Almost all patients have muscle weakness( atony), jawing of the lower jaw, trunk, limbs. In this case, the motions become shallow, with a small amplitude of movements. Tremor can be so strong that the patient literally shudders in convulsions. In addition, a fairly frequent companion of all types of delirium is convulsions, often they can be caused by the growing swelling of the brain.

Infectious delirium most often develops at the peak of the infectious process. Very often the causes of it are severe forms of pneumonia, typhus, childhood infections. In some cases, delirium does not appear suddenly, it can have harbingers - increased anxiety, excessive activity in bed, patients can not lie, all the time they stop to get up, anorexia develops, some patients become very sensitive to bright light, loud sounds. All these phenomena develop against the background of extremely high temperatures.

In the evening, usually there is an increase in symptoms, patients begin to scream, their speech is incoherent, the movements become chaotic, sometimes unrestrained fear develops, which causes the patients to jump out of bed and escape from imaginary pursuers. He listens and looks at others, while not at all oriented in his location, but answers questions about himself clearly and correctly. By the morning manifestations subside, consciousness can clear up, but with the onset of the night everything repeats anew. Without treatment, patients can completely exhaust their strength and die from exhaustion of all organs and systems.

Mutating delirium is called a silent consciousness disorder, which develops during a severe course of internal diseases. Also, it can be with alcoholism, poisoning with heavy metals, some medications, for example, sulfanilamide preparations, atropine. This kind of delirium quickly enough passes into a sopor, and without the timely help and to whom.

The patient develops high motor activity against the backdrop of the height of the disease, which, however, does not go beyond the bed. The patient practically does not fix sight, does not answer questions and does not react to external stimuli. His speech is quiet and incoherent, there are small convulsive contractions in his hands. In most cases, patients develop cerebral edema. The duration of this form of clouding of consciousness can be from one to two days to a week.

The old delirium( senile delirium), as the name suggests, develops in old age, is accompanied by a sharp decline in intelligence, the loss of all previous knowledge and skills, as well as poor visual hallucinatory experiences and repetitive movements typical of, for example, their past professional activities. The speech of such patients is often silent, incomprehensible. In general, it develops against the backdrop of serious somatic diseases.

Dementia is a dementia acquired with age, the main causes of which is a huge list of diseases from multiple sclerosis and arterial hypertension to alcoholism and suffered craniocerebral trauma. With dementia, the patient disintegrates. Delirium on the background of dementia often develops gradually, but in most cases it is the developed dementia that is the impetus for the development of delirium.

Often, people suffering from senile delirium are activated at night, characteristic of them are unexpected fees for any fictional move. However, quite often the symptoms of delirium remain unnoticed, they are written off to the existing dementia.

Usually patients are presented with complaints of increased fatigue during the day, poor attention concentration, anxiety or depressive condition. One of the first signs is often nightmarish dreams, which patients are little different from reality. Many old people in the state of delirium appear illogical thoughts, they are not able to think critically. Symptoms can change even throughout the day, but the deterioration still occurs at night. Gradually, the bright gaps become shorter, and a moment comes when they cease to appear at all.

Postoperative delirium is one of the rather rare types of complications after severe operations, more common in elderly patients. The risk factor may be general or regional( epidural) anesthesia, prolonged operation, violation of water-salt metabolism( hypernatremia), large blood loss, history of alcohol abuse, cardiovascular diseases. Delirium can develop as a type of excitation, and with the depression of neuro-psychic functions or have mixed manifestations.

Alcoholic delirium is a disorder of the psyche, in which the state of delusions, hallucinations, fever and heavy sweats with chills develop. Hallucinatory pictures are aggressive, frightening in nature, in which there is an imaginary threat to the patient or those around him. Often visions are of a mixed nature, so visual images can be combined with auditory and tactile false hallucinations. The patient is very excited and can not adequately respond to others, while he does not consider himself a patient, and his behavior is strange. The main danger of this condition is that the patient can inflict life-threatening traumas.

Alcoholic delirium never develops on the background of alcoholic intoxication, but after abstinence for several days from drinking, the probability of delirium development is very high. Thus, it is the abstinence state with delirium that is most characteristic on days 4-5 from the moment of refusal to take the usual doses of alcohol. A fairly typical manifestation of alcoholic delirium is its onset in the evening or at night. Symptoms can appear immediately, but also possibly a time-extended manifestation of all symptoms.