St. Clair checkup: what is delirium?

Delirium is a syndrome characterized by a sudden change in an individual’s mental state or behavior. It can occur in hospitalized patients who become confused in their thinking and their perception of their environment.

The onset of delirium is rapid, with symptoms appearing within hours or over a few days. Symptoms may include restlessness, rambling or illogical speech, inability to focus, hallucinations, disorientation and personality changes, including aggression. Symptoms may fluctuate and are frequently worse at night.

Delirium can be alarming to family members, who are often the first to note the sudden change. They may be concerned that their loved one has developed dementia, which has similar symptoms. However, dementia is generally a chronic rather than acute condition.

Delirium has many causes and can happen at any age, explains Kathe Dvorsak, M.S.N., R.N., Director of Psychiatry and Mental Health Services at St. Clair Hospital. These include infections, such as pneumonia or a urinary tract infection; imbalances in the blood chemistry, as a result of illness or dehydration; fever; extreme pain; sleep deprivation; medication side effects; and drug or alcohol withdrawal. Delirium can be worse for those with sensory deficits, such as vision or hearing loss. For older adults, one of these factors, plus the change in environment that hospital admission entails, can trigger delirium.

Since patients with delirium can be very difficult to care for and their safety is a priority, a special Delirium Task Force led by Dvorsak and psychiatrist Bruce A. Wright, M.D., chair of the St. Clair Department of Psychiatry, was developed at St. Clair. The task force works to improve the early identification and treatment of patients with delirium. Delirium Task Force members include physicians, nurses, and a pharmacist; they have developed a protocol and an education program to help physicians and nursing staff recognize delirium, including the CAM (Confusion Assessment Method). In addition, education was provided on evidence-based standards of treatment, including appropriate medications to alleviate the patient’s symptoms, hydration and pain relief, and environmental modifications.

Medical management of delirium includes reversing the conditions that brought it on. The symptoms of delirium may persist after the underlying problem has been treated. Providing emotional support to the patient and family is paramount.

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