Delirium is a state of mental confusion which develops quickly and usually fluctuates in intensity. A state in which the thoughts, expressions, and actions are wild, irregular, and incoherent; mental aberration; a roving or wandering of the mind, — usually dependent on a fever or some other disease, and so distinguished from mania, or madness.
Delirium is a serious medical illness which causes disturbance in mental abilities of a person, results in to confused thinking, difficult comprehension and decreased awareness of environment.
Consciousness is defined as the state of awareness of self and the environment.
It is an acute, transient, usually reversible mental disorder.
A person with delirium may not be able to follow even discussion, or he may fall asleep in the middle of a conversation. He may suddenly have no idea what is happening, may not know where he is. While most of the patients with delirium become sleepy, some become anxious and restless, in severe cases, they hallucinate and panic.
Delrium, Mental Confusion – Homeopathy Treatment & Homeopathic Remedies
Homeopathy treats the person as a whole. It means that homeopathic treatment focuses on the patient as a person, as well as his pathological condition. The homeopathic medicines are selected after a full individualizing examination and case-analysis, which includes the medical history of the patient, physical and mental constitution etc. A miasmatic tendency (predisposition/susceptibility) is also often taken into account for the treatment of chronic conditions. The homeopathic remedies for delirium given below indicate the therapeutic affinity but this is not a complete and definite guide to the treatment of this condition. The symptoms listed against each medicine may not be directly related to this disease because in homeopathy general symptoms and constitutional indications are also taken into account for selecting a homeopathic remedy for delirium. To study any of the following remedies in more detail, please visit our Materia Medica section. None of these homeopathic medicines should be taken without professional advice.
- Veratrum album
- Cannabis indica
- Arnica montana
- Hellebores niger
- Argentums nitricum
- Belladonna comes to mind first in delirium. It has a violent delirium with loud laughing screaming out, and grinding of the teeth, and, as in all narcotics, a desire to hide or escape.
- The patient is full of fears and imaginings, and the delirium manifests itself by the most positive ebullition’s of rage and fury.
- Its general character is one of great activity with great excitement, a hot face and head and often times there is present a sensation as if falling and the patient clutches the air.
- Sometimes there is a stupor, and when aroused they strike people bark and bite like a dog and are most violent.
- This remedy has not the intensely high degree of maniacal excitement that we find under Stramonium, nor has it the cerebral congestion that characterizes Belladonna.
- With Hyoscyamus there is an aversion to light, and the patient fears being poisoned; he will sit up in bed, talk and mutter all the time, and look wildly about him.
- There is a great deal of nervousness, whining, crying and twitching; he tries to escape from imaginary foes; a constant picking at the bedclothes and objects in the air is most characteristic.
- It is the remedy for that curious condition of delirium known as “coma vigil.:’
- With this remedy the delirium is more furious, the mania more acute and the Sensorium more perverted and excited than under Belladonna or Hyoscyamus.
- The patient desires light and company, is very loquacious, garrulous, laughs, sings, swears, prays, curses and makes rhymes.
- He sees ghosts, talks with spirits and hears voices.
- The head is raised frequently from the pillow, the face is bright red, and he has a terrified expression; in fact, he seems to see objects rising from every corner to frighten him. Sometimes a silly delirium is present.
- Veratrum has restlessness, and a desire to cut and tear the clothing as in Belladonna; but with this remedy there is a coldness of the surface of the body and a cold sweat.
- The patient is loquacious, talks very loud and is frightened at imaginary things.
- It also has a states of frenzy or excitement, during which he indulges in shrieks, in expressions of fright and in violent cursings of those around him.
- The delirium of Phosphorus is of a low typhoid type, with tendency to haemorrhage and an apathetic, sluggish, stupid state, where the patient is unwilling to talk and answers question slowly.
- It has also an ecstatic state, in which he sees all sorts of faces grinning at him.
- He has also imaginary notions, such as imagining that his body is in fragments.
- It has most remarkable hallucinations and imaginations, exaggeration of the duration of time and extent of space, being most characteristic.
- Conception of time, space and place is gone. Extremely happy and contented, nothing troubles. Ideas crowd upon each other.
- Has great soothing influence in many nervous disorders, like epilepsy, mania, dementia, delirium tremens, and irritable reflexes.
- Excessive loquacity; exuberance of spirits. Time seems too long; seconds seem ages; a few rods an immense distance.
- Constantly theorizing. Anxious depression; constant fear of becoming insane. Mania, must constantly move.
- Very forgetful; cannot finish sentence. Is lost in delicious thought. Uncontrollable laughter. Delirium tremens. Clairvoyance.
- Emotional excitement; rapid change of mood. Cannot realize her identity, chronic vertigo as of floating off.
- It has conditions upon the system quite similar to those resulting from injuries, falls, blows, contusions.
- Fears touch, or the approach of anyone.
- Unconscious; when spoken to answers correctly, but relapses.
- Indifference; inability to perform continuous active work; morose, delirious. Nervous; cannot bear pain; whole body oversensitive.
- Says there is nothing the matter with him. Wants to be let alone. Agoraphobia (fear of space). After mental strain or shock.
- Dr. Bayes praises this remedy highly in the delirium of typhoid fever, where there are constant attempts to get out of bed and tremor of the whole body.
What make you susceptible to have Delirium?
-Pre-existing brain disease (e.g., dementia, stroke)
-Infection (e.g., UTI, pneumonia)
-Critical or terminal illness (biventricular failure, cancer, cerebrovascular disease)
-Psychiatric illness (e.g., depression)
-Sensory impairment (vision, hearing)
-Dehydration / malnutrition
Symptoms of Delirium
- Consciousness level altered
- Disorientation to time and sometimes place or person.
- There may be hallucinations, delusions, and paranoia.
- Confusion regarding day-to-day events and daily routines is common, as are changes in personality and affect.
- Speech is often disordered, with prominent slurring, rapidity, neologisms, aphasic errors, or chaotic patterns.
- Other symptoms may include inappropriate behavior, fearfulness, and paranoia.
- Patients may become irritable, agitated, hyperactive, and hyperalert, or they may become quiet, withdrawn, and lethargic.
- Disorganized daily activities like patterns of sleeping and eating are grossly distorted.
- Symptoms of delirium fluctuate over minutes to hours; they may lessen during the day and worsen at night.
- Other symptoms and signs depend on the cause.
Forms of delirium
Delirium may present in
- Hyperactive – it is manifested as severe confusion and disorientation, developing with relatively rapid onset and fluctuating in intensity.
- Hypoactive – it is manifested by an equally sudden withdrawal from interaction with the outside world. Misdiagnosed as depression.
- Mixed – patient may fluctuate between both hyper- and hypoactive periods.
Patho-physiology of Delirium
The Diagnostic and Statistical Manual of Mental Disorders (DSM) is published by the American Psychiatric Association (APA) and offers a common language and standard criteria for the classification of mental disorders.
The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) diagnostic criteria for delirium is as follows :
- Disturbance in attention (i.e, reduced ability to direct, focus, sustain, and shift attention) and awareness.
- Change in cognition (e.g, memory deficit, disorientation, language disturbance, perceptual disturbance) that is not better accounted for by a preexisting, established, or evolving dementia.
- The disturbance develops over a short period (usually hours to days) and tends to fluctuate during the course of the day.
- There is evidence from the history, physical examination, or laboratory findings that the disturbance is caused by a direct physiologic consequence of a general medical condition, an intoxicating substance, medication use, or more than one cause.
Investigation for Delirium
Although diagnosis of delirium is based on clinical symptoms but it is essential to identify the cause in order to treat and manage the case.
It may include:
- Complete blood count, serum glucose, electrolytes, and urinalysis
- Urine toxicology or serum drug levels to exclude drug abuse.
- Serum creatinine, BUN, liver function tests, arterial blood gas
- Chest x-ray to rule out lung infection like pneumonia.
- For cardiac etiology (e.g., myocardial infarction, arrhythmia) – ECG
- If patient has focal neurological deficits or the initial workup is negative, further tests may include
- CT, MRI
- lumbar puncture: to rule our meningitis/encephalitis
- EEG: especially if the patient has a history of head trauma, stroke, or brain lesions
- Further diagnostics that may be considered: blood culture, thyroid function tests, vitamin b12, HIV, syphilis serology
Conventional treatment for Delirium
The treatment for delirium with medications depends on its cause. Antipsychotics, particularly haloperidol, are the most commonly used drugs for delirium.