Acute Delirium

Bouffée délirante aiguë

Acute Delirium– As usually observed in adolescents or young adults 20 to 30 years

– According to Magnan is a “delirium outset, a thunderbolt in a serene sky.” The onset is sudden and brutal sometimes preceded by nonspecific prodrome (driving quirk, insomnia, irritability)

– The delusional syndrome with delirium lived intensely, characterized by its wealth, its polymorphism in themes and mechanisms; its lack of systematization and its variability over time.

– The most common themes were the persecution and influence;Also, mystical idea, erotic or size.

– The organizers of delirium mechanisms include hallucinatory phenomena; imagination; intuition and interpretation

– The mental automatism is practically constant (loss of privacy of thought orders …)

– The organization of delirium is poorly structured, not systematic. This is usually more of an experience than a delusional development. Delirium causes total conviction of the subject

– The anxiety is always present, usually with intense agitation, frequently associated with depersonalization disorder and derealization

– The thymic participation is constant, rapidly fluctuating during the day (prostration  euphoria)

– Disruption of psychomotor state is the rule

– The level of consciousness can be altered without real mental confusion (no real disorientation in time and space; vigilance and fixing memory are preserved). Attention is focused on the delusional experience generating high distractibility.

– Somatic symptoms: insomnia virtually constant; dehydration with hypotension and oliguria

– The natural course is to complete resolution within weeks with criticism of the episode.

– In the long term, there are 3 evolutionary modes: full remission without recurrence (⅓ of cases); repeat (1/3 of cases); chronic schizophrenia-like psychosis (⅓ of cases).

– ELEMENTS OF GOOD PROGNOSIS: family history of mood disorders; absence of pathological personality; sudden onset; triggering factor; short and noisy nature of the clinical picture; polymorphism of delirium; the intensity of the mood and anxiety participation; good response to treatment; critique of delusional episode remotely.

1- BDA: summary :

A- Themes:

polymorph; All subjects met: persecution, eroticism, filiation (identity), possession, damnation, depersonalization-derealization

B- Mechanism:

polymorph; hallucination, interpretation, intuition, imagination

C- Consciousness:

Disorders of consciousness are present but fluctuating (+ oscillating mood disorders)

D- Etiology:

* Personality factors: schizoid personality (introversion) or narcissistic, immature, selfish

* Event Factors: disasters; death of a relative; humiliation; professional failure

* Toxic factors: alcohol; cannabis and other hallucinogens

E- Treatment:

The importance of hallucinatory signs opted made to haloperidol (+ chlorpromazine)

2- Confuso-dreamlike Syndrome:

A- CONFUSION SYNDROME:

* Impaired vigilance

* Temporo-spatial disorientation

* Anterograde amnesia

* Fluctuation nycthemeral performance

* Anxious perplexity

* Onirisme (zoopsie, macropsia)

B- ETIOLOGIES:

* Infectious causes (encephalitis)

* Metabolic (hypoglycemia)

* Endocrine (hyperthyroidism, hypothyroidism)

* Neurological (trauma, epilepsy, stroke …)

* Post-emotional! (Elderly)

* Toxic: (pharmacopsychose)

– Amphetamines; Cocaine -> confuso-delusional forms interpretative

– Cannabis, LSD, anticholinergics -> hallucinatory phenomena

– Alcohol: evil led weaning -> delirium tremens