Delirium is a neuropsychiatric condition characterized by an acute, fluctuating course, and changes in one’s arousal and attention span. In other words, a patient may seem fine in the morning, have virtually no attention span during afternoon rounds, and be back to normal by dinner time. Conditions like Alzheimer’s are more chronic and gradual, so they’re not categorized as “delirium”, per se, although a decrease in the neurotransmitter acetylcholine has been implicated in both cases.
Certain populations are more susceptible to delirium, namely the elderly and those with existing mental conditions like dementia. It can be brought on by a tremendous variety of infectious, metabolic, and neuro processes making treatment difficult in many cases.
So how does this relate to our patients?
Let’s consider a simple scenario: John Doe notices his dad has been coughing a lot over the last two days, and started producing blood-tinged sputum this morning. He rushes his family member to the hospital and leaves to pick his sister up from the airport, so they can both come back and stay with their dad overnight. Upon returning, the patient seems lethargic and isn’t oriented to person, place, or time. He doesn’t pay attention to his kids whatsoever and requires forceful stimulation (firmly tapping his chest) to elicit a brief moment of eye contact.
Mental status is the link between a patient and his or her loved ones.
While at the bedside, John Doe and his sister could care less what their dad’s electrolytes are. Or what the chest X-ray could possibly show. Or how much of the hospital costs their insurance provider is going to cover. Loved ones care if the patient can appreciate an inside joke they share, what’s going on at school, what their plans are next week, etc. Imagine dropping off your parent in a stable mental condition only to be unacknowledged by them 12 hours later. If John Doe’s dad had pneumonia, congestive heart failure, or even terminal cancer, at least the “link” they share would still be preserved. They could share stories over laughter and be optimistic about the treatment course. But seeing a loved one fall into delirium… wow.
Delirium is indeed a medical emergency putting patients at an increased risk for morbidity and mortality; however, it seems that the impact it can have on the loved ones of a patient can be even more detrimental.