Delirium

WHEN TO SEE YOUR DOCTOR

* Anyone experiencing delirium needs immediate medical attention.

What Your Symptom Is Telling You

Delirium comes on like a dense fog rising out of the cool night air. It envelops your mind in a shroud of confusion, where everyone seems like a stranger. You don't know where you are or what day it is.

Scary? You bet. Perplexing? No doubt. But there's an excellent chance of quickly re-establishing a link with reality with prompt medical care.

Delirium develops within minutes and can last for days, disrupting the workings of the brain in ways that are still unclear to medical researchers, says Larry Westreich, M.D., a psychiatrist at Bellevue Hospital Center in New York City. Even during the worst attack of delirium, a person can have moments of rational thought before suddenly falling back into never-never land.

Many things can cause delirium, including high fever, alcohol abuse, illegal drugs such as marijuana and cocaine or even a knock on the head. Sometimes delirium comes as a side effect of certain medications, such as cimetidine, used for ulcers, or corticosteroids, used for inflammation. Delirium can also be a sign of serious disease such as appendicitis, epilepsy, diabetes, heart disease or stroke.

Symptom Relief

Delirium can signal a potentially life-threatening ailment, and you should seek medical care immediately," Dr. Westreich says.

While help is on the way, here are a few things you can do to make a delirious person more comfortable and help doctors make the right diagnosis.

Let nothing past the lips. Don't let a delirious person eat or drink anything, advises Steven Mandel, M.D., clinical professor of neurology at Jefferson Medical College and an attending physician at Thomas Jefferson University Hospital in Philadelphia. Doctors may also have to pump the person's stomach to remove drugs that may be causing the delirium. In addition, if the delirium is caused by appendicitis or some other ailment that requires surgery, food or drink may complicate the procedure, Dr. Westreich says.

Nab the culprit. Scan the area near the person who is delirious for prescription medications, illegal drugs and drug paraphernalia such as pipes or needles. If you find any, make sure that a doctor, nurse or emergency medical technician knows about it.

Be on guard. Never leave a delirious person alone, says Peter Roy-Byrne, M.D., professor of psychiatry at the University of Washington and chief of psychiatry at Harborview Medical Center in Seattle. "You shouldn't assume that a delirious person is capable of taking care of themselves," he says. "If the person says, 'Leave me alone. I just need to go outside and get some air,' don't let him. He may lapse back into delirium and wander out into the street."

Speak softly. "As a person becomes delirious, they often get frightened," says Alan Unis, M.D., assistant professor of psychiatry and behavioral sciences at the University of Washington School of Medicine in Seattle. "Talk to the person in a calm voice. Let the person know where he is, assure him that you won't leave him alone and tell him that help is on the way."

Keep it one-on-one. The delirious person might become more frightened and confused if several people are talking to him, says Dr. Westreich. He suggests one person do all the talking.