Delirium is a condition where acute changes in global brain functioning occurs. Delirium can occur in patients with focal brain lesions as well as meningitis. The behavioral manifestations of delirium can be misdiagnosed as a functional psychosis and delay recognition of an underlying treatable organic brain disease. It is important to recognize delirium, as it is often an early manifestation of the conditions mentioned in 1.1 and 1.2 above and often precedes the more severe disturbance of consciousness - coma.
The central features of delirium that distinguishes it from acute functional psychoses include impairment in orientation and memory (test for registration and immediate recall) that manifests as poor recall of recent events, misidentification of people, fear and loosely held persecutory ideas. It is important to formally assess orientation and memory, rather than depend on just observations of the patients behavior as changes in behavior are often seen in both patients with functional and organic brain syndromes and are not sufficiently specific for either condition to allow for distinguishing one from the other.
• Less sedating major tranquilizers such as Haloperidol should be used at low doses (3-9 mg daily, titrate dose to response making changes in drug dose after one hour of observation of effects if acutely agitated on day of initiation of parenteral treatment and at least after 3 days of observation of effects if on oral medication) to control these symptoms, while treating underlying causes of organic brain disease. The choice of Haloperidol is also because it does not lower the seizure threshold and thus does not predispose patients who are already vulnerable to developing seizures to have them.
• Assess after patient calm - usually after one week of treatment, to rule out underlying depression, mixed depression and anxiety or anxiety disorder and treat accordingly.