Acute Confusional States

A state of acute confusion is also called delirium or organic brain syndrome. It is a condition where the brain does not function normally due to another disease. In elderly people, infection, dehydration and drug effects are the most common causes of delirium. One example of delirium is feverish hallucinations. Delirium can be similar to dementia at times. In practice, a delirium always disappears when the underlying disease has been treated. Delirium develops more easily if the person also has a dementia disease.

Acute confusional states can be caused by many physical diseases and conditions. The most common causes among elderly people are:

• medication side-effects and interactions
• physical diseases, particularly bladder infection, pneumonia
• abrupt cessation of alcohol or sedative medication (benzodiazepines)

Confusional states can arise acutely or subacutely in the course of hours or days. They usually last from a few days up to one week.

During the course, the patient may experience fairly dramatic delusions of persecution (for example becoming enclosed in horrible surroundings that put him or her in mortal danger or being exposed to poisoning).

Visual hallucinations occur frequently. There are often involving fire and water, for example fire in the bed or in the hallway or water rushing in like a tidal wave. The experiences are, of course, related to anxiety, fear or horror and are perceived as ‘real’ by the patient.

The delirious person often fails to recognise family or nursing staff.

A very common cause of delirium is urinary tract infection or urinary retention where the person is unable to urinate. Other infections, constipation and other physical diseases can also cause delirium. It is always important to review medication consumption. Sudden cessation of alcohol or some medicines, sedative drugs in particular, can provoke a confusional state.