Abnormal Psychology

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

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