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Delirium

fever, diseases, motor, seen, example and causes

DELIRIUM is a general disturbance of consciousness, a perversion of the intellectual and perceptive faculties, characterized by a greater or less degree of mental confusion, by more or less transitory delusions and fleeting hallucinations, often accompanied by disordered, senseless speech and muttering, and motor un rest. It varies in degree from the ordinary wandering or flightiness of mild types, such as fever deliriums, to the higher, excited or more violent form, which are then termed maniacal delirium, as seen in delirium tremens, general paresis, katatonia, epileptic or manic-depressive patients. It is a frequent symptom of many brain disorders. Present day psychiatry does not recognize— or designate—any one mental disorder by the term delirium. It is a symptom of many mental disorders. The delirium grave which still persists as a term in psychiatry is an exhaustion or toxic delirium — not a disease per se.

There are innumerable causes of delirium, the more prominent ones being infectious fevers, in the young and able-bodied, diseases dependent upon some specific micro-organism, such as is seen in typhoid fever, pneumonia, scarlet fever, yellow fever, puerperal fever, pyemia and malaria; although delirium occurs also in analo gous diseases not proven directly due to any specific micro-organism, also in trauma. Surgi cal operations are frequently followed by delir ium.

In the delirium of intoxication the causes may be divided into endogenous and exogenous, the former arising from within the body proper, such as septic intoxication, pyemic or uremic absorption, cholemia, diabetes, auto-intoxication and Insolation, that is, sunstroke. The latter (exogenous) causes are alcohol, drugs, mydriat ics, for example, belladonna, duboism, atropin; also cocaine, morphine, mineral poisons, for ex ample, iodoform.

Delirium due to exhaustion and inanition is seen in acute anaemia, resulting from haem orrhage of any cause, or the presence in the blood of powerful Ireinic poisons, for example, plasmodium of malaria. It is also due to wast

ing diseases and lactation.

Delirium may originate in central or periph eral lesions of the brain, for example, blood clot from accidental injury, trauma, surgical operations, meningitis or encephalitis. Delirium may also be due to, or associated with, central depression, notably that occasioned by epilepsy, hysteria major, etc.

Delirium of senility is due to inanition and pathologic changes in the cerebral vascular sup ply.

The delirium of disease, or acute delirium, resembles that arising during febrile diseases; it is ordinarily accompanied by rise of tempera ture, which pursues no definite course, and by rapid and progressive body weakness (asthenia), and the typhoid state. The treatment consists of utilizing remedial agents that rapidly pro duce sleep, and fighting the progressive weak ness, by stimulating drugs and nutrition, quiet ing the motor unrest and reducing fever by hydrotherapy, etc.

The treatment of delirium in general is first: Induce sleep, and quiet motor unrest; this is best accomplished by the reduction of fever, the exhibition of proper narcotics, thorough cleansing of the intestinal tract and hydrotherapy. In the selection of hypnotics, the one or the group which is followed by the least depression is advisable. Hyoscamine, in sthenic cases is safe and reliable. Bromide of potassium, chloral hydrate, hyoscin, morphine and opium and the various synthetic coal tar derivatives are frequently used. Second: Dis cover, if possible, and remove the inciting cause of delirium; to do this the pathological factor must be determined and treated accordingly.