Place of delirium in the disorder classification
In clinical practice, delirium is included in the group of clouded states of consciousness. Such conditions are characterized by pronounced psychomotor agitation and an abundance of vivid productive disorders. Due to the potential threat to the patient and others, the appearance of such signs serves as a direct indication for emergency psychiatric intervention.
Within the framework of organic, exogenous, and somatogenic disorders, delirium acts as a specific manifestation detected exclusively in organic lesions. Such disturbances are viewed more broadly than in neurology: even temporary intoxication without irreversible structural brain changes is regarded by psychiatrists as a global process leading to the loss of vital memory and thinking functions.
Clinical features and risk groups
Manifestations of delirious states require close attention from medical personnel. The characteristic features of managing such patients include:
- The necessity to remain constantly at the patient's bedside when there is a high risk of developing delirium.
- The emergence of a special form of delusion, in particular, Othello syndrome (delusion of jealousy).
- Predominant involvement of a specific demographic stratum — elderly men.
- The emergence of a special type of exogenous psychosis, such as anticholinergic delirium during intoxications.
Emergency care and management of agitation
Since psychomotor agitation in clouded states of consciousness can lead to dangerous actions (attempts to jump out a window, running onto a roadway), the fastest possible management of the condition and hospitalization are required.
- Communication: the doctor conducts a calm and persistent conversation, demonstrating self-possession and a desire to help.
- Pharmacotherapy: the drugs of choice are antipsychotics, prior to the administration of which initial blood pressure must be measured to prevent sudden hypotension.
- Alternative: in the presence of contraindications to antipsychotics, benzodiazepine tranquilizers (diazepam, phenazepam, lorazepam) are used.
Delirium — Detective Loves Bright Pictures: Delirium = clouded consciousness + psychomotor agitation + vivid productive symptoms.
Class and exam questions
Which group of syndromes does delirium belong to?
Delirium is among the main clouded states of consciousness along with amentia, oneirophrenia, and twilight state of consciousness.
What main manifestations accompany delirium?
It is characterized by psychomotor agitation, vivid productive symptoms, and specific manifestations of an organic nature.
What tactics are used when there is a high risk of delirium?
Medical personnel must constantly remain at the patient's bedside, assessing risks and ensuring safety.
What else to study on this topic
- Features of psychoorganic syndrome and the Walter-Bühl triad
- Differential diagnosis of organic diseases in psychiatry
- Use of antipsychotics and prevention of their side effects
- The role of specialized intensive care units in psychiatry
- Toxicological aspects of exogenous psychoses
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