Category: Neuropsychology

Delirium Generis

Delirium is a term that has gained acceptance within the medical community.  Twenty years ago, a clinician could be maligned for using the term in a clinical setting.  Many providers consider it a popsy, imprecise, if not inappropriate term.  Delirium is actually a precise clinical term that may have profound consequences for the afflicted.  It is a cognitive state in which the person is unable to focus their immediate attention.

Schizophrenics are often incorrectly labelled as being in a delirium.  Their stream of thought is bizarre and often not pertinent to the immediate situation.  While their attention is reduced by the automatic thoughts, schizophrenics are rarely delirious.  Similarly, people who suffer with mania or are highly anxious may be labelled with a delirium, but this is also a rare situation.  While automatic and unwanted thoughts decrease their attention, these unfortunate individuals are still able to focus their attention at a reduced level.

Individuals suffering with a delirium have an impairment of immediate attention.  The attentional deficit far surpasses that observed in people with an Attention-deficit Disorder, which is typically a disorder of sustained attention-not immediate attention.  It is not a dream world, since this presupposes the sustained attention to be consistently unrealistic.  It is an acute condition that is typically caused by a metabolic or an infectious process.  Delirium is more a sign of medical illness than psychological distress.  A person immersed in a delirium may incur increasing organic damage the longer they remain in this state.  Urinary infections, severe dehydration, head injury, stroke and an elevated intracranial pressure may produce a state of delirium.  Psychoactive drug use and allergic reactions may also produce a state of delirium.  Alcohol and tranquilizer withdrawal are two of the more common causes of delirium.

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Managing a person suffering with a delirium is best accomplished with a smile.  Since their attention is too impoverished to comprehend well, the patient will tend to focus on the examiner’s facial expression.  Gentle physical guidance is almost always required, secondary to the poor aural comprehension.  The main task of the caregiver is to protect the person from accidental harm until medical services can intervene.  It is not suggested to wait for the delirium to pass, since there may be increasing organic damage without the appropriate treatment for the underlying condition.  Even if the caregiver knows that severe dehydration if causing the delirium, convincing the person to drink voluntarily is nearly impossible.  If a person was able to understand the caregiver’s concern and act accordingly, this would be proof enough that the person is not in a state of delirium.

No matter how skilled the caregiver, delirium presents an emergency that requires coordinated medical care.  A highly skilled caregiver is apt to know their limitations and seek timely medical intervention.  Less skilled caregivers may wait for the condition to pass.  Even worse, the caregiver may perceive the patient’s delirium as a personal commentary on their skill as a caregiver.  Be a skilled caregiver and seek medical intervention as soon as possible.

Lifestyle and Mental Health

The following is a condensation of a literature review by Dr. Roger Walsh.  It appeared recently in the American Psychologist, a journal of the American Psychological Association.  Please review the suggested Therapeutic Lifestyle Changes (TLC).  These scientifically derived principles for living may benefit those suffering from cognitive and emotional impairments.  Fortunately, most of the article is less abstract than practical, and has the additional appeal of common sense.  Let us not forget that common sense is anything but common-to paraphrase Mark Twain.

Exercise is one of the most reviled words in the English language.  When most people feel like exercising, they lay down until the feeling passes.  Another paraphrase of Twain.  Joking aside, the influence of exercise on mild to moderate depression has been studied extensively.  Its therapeutic benefits compare favorably with medication and psychotherapy.  Higher intensity workouts appear to be more effective than lower intensity, but the exact guidelines for each level of intensity is unclear.  The effect of exercise on cognition is very good news.  For the young, it enhances academic performance.  For the elderly, it is an important aide to stroke recovery.  Exercise reduces geriatric memory loss, reduces the risk of Alzheimer’s Disease by 45%, and reduces the risk of other dementing conditions as well.  Exercise programs of one to three months offer significant cognitive benefits, but those lasting more than six months are more beneficial.  The benefits are even more significant if the exercise lasts more than thirty minutes, and combines both aerobic and strength training components.

Diet may be the second most reviled word in the English language.  It is often used to denote controlled starvation in popular literature, but it is not the meaning discussed in Dr. Walsh’s article.  It simply means one’s choice of food items.  Not surprisingly, the chemicals ingested into our body from food have a significant impact on cognitive and emotional health.  The best diet is miserably close to what our parents forced us to eat!  The diet should be rich in fruits and vegetables, contains some fish, and an eye should be kept on reducing calories. This sort of dietary intake appears to enhance cognitive and academic performance in children, and reduce the severity of mood and psychotic disorders in adults.  There is also a reduction in age-related cognitive decline, Alzheimer’s Disease and Parkinson’s Disease.
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The influence of supplements on lifestyle has skyrocketed in the last twenty years.  The supplements that appear to have a real benefit on cognition and/or mood are Vitamin D, S-adenosyl-methionine, folic acid and fish oil.  The benefit appears to be the greatest with fish oil, in relatively high doses of nearly one gram per day, which entails the ingestion of multiple capsules.  The fish oil may slow the clotting of blood, such that mixing with other anticoagulants is not suggested.  In older adults, the use of fish oil reduces cognitive decline, but is not effective as a treatment for Alzheimer’s Disease.  Fish oil may also reduce aggression in children and adults, prevent the onset of psychosis in high risk youth, and have a modest benefit for those suffering with schizophrenia and Huntington’s Disease.  Lastly, given its action as an anticoagulant, consider reducing or discontinuing it usage if unusual bruising appears, as well as bleeding from the nose or in the throat.  Do not forget that supplements and medications are to enhance and prolong our life.  Be quick to reduce or discontinue usage if it is having an overall negative affect.  It is easy to focus on the intended benefits, to the exclusion of significant detriments.

The next post will delve further into Dr. Walsh’s literature review.  The role of relationships, spirituality, nature and giving to others will be examined in terms of their effect on mental health.