Abnormal Psychology

(やまだぃちぅ) #1

Cognitive Disorders 693


How do clinicians determine the underlying cause of

an individual’s delirium? From a physical examination, a


consultation with someone who knows the patient and


may know something about what led to the symptoms,


results of laboratory tests, and a review of the patient’s


medical history. In some cases, the clinician may need to


evaluate the patient a number of times over the course


of a day or over several days to determine the specifi c


cause of the delirium (or whether, in fact, the diagnosis


of delirium is most appropriate; Kessler, 2006). Delirium


can be caused by more than one factor; for example, if


someone with alcohol dependence develops an infection


and doesn’t drink alcohol while the fever is raging, that


person’s delirium might well arise from both the DTs


and the fever.


Treating Delirium: Rectify the Cause


Most often, treatment for delirium targets neurological factors—treating the un-


derlying medical condition or substance use that affects the brain and gives rise


to the delirium. In most cases, as the medical condition improves or the substance


intoxication or withdrawal resolves, the delirium ends. In some cases, though,


treatment for the underlying medical problem—for example, administering an-


tibiotics to treat bacterial pneumonia—can take days to affect the delirium; in


other cases, as arises when people are close to death, doctors may not be able


to treat the underlying cause of the delirium. For temporary relief, the patient


may be given antipsychotic medication for the delirious symptoms, usually halo-


peridol or risperidone (Leentjens & van der Mast, 2005). In fact, studies fi nd


that giving haloperidol preventatively to elderly patients about to undergo sur-


gery can decrease the severity and duration of postoperative delirium (Kalisvaart


et al., 2005).


Treatment may also target psychological and social factors. Such interventions

for people with delirium include (Brown & Boyle, 2002):



  • providing hearing aids or eyeglasses to eliminate sensory and perceptual im-


pairments;


  • teaching the patient to focus on the here and now, by providing very visible clocks


and calendars or other devices and encouraging the patient to use them;


  • creating an environment that optimizes stimulation, perhaps by providing ade-


quate lighting and reducing unnecessary noise;


  • ensuring that the patient is fed and warm;

  • making the environment safe by removing objects with which the patient could


harm himself or herself or others; and


  • educating the people who interact with the patient (residential staff, friends, and


family members) about delirium.

Key Concepts and Facts About Delirium



  • According to DSM-IV-TR, delirium is characterized by a distur-
    bance in consciousness and changes in cognitive functioning
    (particularly in attention). These symptoms develop rapidly and
    fl uctuate over the course of a 24-hour period.

    • When delirious, people may not know where they are, who
      they are, or what day (or year) it is. They may also misinterpret
      stimuli and experience illusions or have hallucinations. Because
      they believe that these perceptual alterations are real, patients




Delirium can arise from a variety of medical prob-
lems, including dehydration, or after receiving
anesthesia. A percentage of surgery patients—
particularly elderly ones—become temporarily
delirious in response to anesthesia.

Gabe Palmer/Corbis

continued on next page
Free download pdf