The task of identifying the etiological significance of behaviorally abnormal patterns, exhibited by a particular individual, has always been considered a rather challenging one. This is because, even today, the pathogenesis of many mental illnesses remains the subject of continual debates. Nevertheless, it is still quite possible to gain a preliminary insight into what may account for the proper approach towards diagnosing mentally ill persons by the mean of analyzing and classifying the qualitative subtleties of their visually observed behavioral inadequateness. In this paper, I will aim to do just that, while promoting the idea that the symptoms, described in the provided case scenario, suggest that the individual in question (Jack) may, in fact, have suffered from the specific form of mental impairment, commonly known as delirium. According to Duppils and Wikblad, “Delirium is a disturbance of consciousness with reduced ability to focus, sustain or shift attention. Further, it is a change in cognition… that develops over a short period of time” (2004, p. 610).
The integral elements of a rationale for me to come up with this preliminary diagnosis can be outlined as follows:
- As it was mentioned in the case scenario, the concerned 28 years old male began exhibiting abnormal behavior while he was at the restaurant. In its turn, this presupposes the spatially non-continual nature of his illness. This is because the case scenario’s description implies that for some time, prior to the catadrome, this individual was acting in a socially appropriate manner (he would not be able to make it to the restaurant if he was in a delirious state of mind all along). And, as psychiatrists are being well aware of, one of the foremost aspects of how delirium manifests itself in affected people is this mental condition’s spatial briefness and the fact that the severity of associated symptoms fluctuates over the course of time (Schuurmans, Duursma & Shortridge-Baggett 2001).
- The relevant information, contained in the case scenario, points out to two predisposing factors of delirium, which might have contributed towards the triggering of this mental condition in Jack – his gender affiliation and the contextual possibility that, prior to having started to exhibit the behavioral emanations of delirium, he might have had a few drinks (the scenario of 28 years old male spending time at the restaurant, well after 8 pm, makes this suggestion rather plausible). This assumption is based upon the earlier mentioned logical possibility, which is I consider it appropriate to elaborate on the scenario’s would-be consequences. The factor of gender affiliation concerns the available statistical data, according to which it is specifically males who are being more susceptible to delirium than females (Hare et al. 2008). The second factor refers to the fact that one’s excessive consumption of alcohol has been well proven as such that significantly increases his or her chances to become delirious (Branco 2011).
- In the provided case scenario, we can also find mentioning of the fact that, one of the reasons why the members of a restaurant’s staff decided to call the ambulance is that Jack appeared abnormally agitated. This gave me another reason to consider that this individual’s visually observable mental abnormality should be discussed within the conceptual/diagnostic framework of delirium. After all, extreme and irrational agitation has been traditionally considered one of hyperactive delirium’s most definitive symptoms. As it was noted by Gillis and MacDonald, “Hyperactive delirium is characterized by hyper-vigilance, agitation, restlessness and disruptive behavior” (2006, p. 20). This again confirms the validity of my preliminary diagnosis.
- d). Another reason why I think that there is indeed a good rationale for diagnosing Jack with delirium is that the case scenario mentioned the fact that, while exhibiting clearly abnormal behavior, Jack appeared thoroughly disoriented. In its turn, the sensation of spatial/cognitive disorientation has been commonly referred to as yet another classic symptom of one’s delirious mental state (Parmet, Lynm & Glass 2004). Therefore, the fact that Jack experienced a hard time while trying to stand on his feet unassisted, may be well regarded as an additional indication that the actual nature of his sporadically manifested mental impairment should be discussed within the context of what we know about the disorder of delirium. It appears that the reason why he demanded to be allowed to call his sister is that the sensation of spatial disorientation, on his part, strengthened the acuteness of Jack’s insecurity-anxieties. Apparently, Jack never ceased being aware that there was something wrong with how he felt, which means that the integrity of his overall ability to indulge in cognition was not strongly affected. This can serve as another indication that Jack was in fact experiencing a delirious state of mind. The only delirium’s feature that does not quite fit the deployed argumentative logic is the fact that this mental disorder targets predominantly elderly people.
- The provided case scenario also specifies that, while exhibiting the signs of mental instability, Jack strived to share what he considered the actual ‘truth’ about the ‘wicked world’ with others. This may suggest that he could have been diagnosed with schizophrenia because one of the schizophrenics’ most common psychological traits is their tendency to remain thoroughly committed to imposing the so-called ‘fixed ideas’ upon other people (Harrow, et al. 2000). Nevertheless, the fact that Jack appeared to be obsessed with the idea of ‘world’s wickedness’ can be well discussed within the conceptual framework of the proposed diagnosis. The reason for this is quite apparent – the observable symptoms of delirium and schizophrenia (in regards to how affected individuals perceive the significance of the surrounding reality) often overlap. Moreover, in some cases, they actually derive out of each other (Fink 1999).
- The state of Jack’s mind appeared to have gone a certain transformation, as he was behaving in a mentally abnormal manner. This indicates a rather rapid development of his mental condition – another common symptom of delirium (Karnik 2007).
- The case scenario also mentioned that, during the course of the incident, Jack was pacing up and down the restaurant – hence, attracting the attention of other people, as they rightly perceived this kind of behavior clearly abnormal. This suggests that, while the incident was taking place, Jack’s psychomotor activity sustained a powerful boost, which provided me with an additional reason to suggest that the concerned individual was experiencing a specifically delirious state of mind (Kiely et al. 2007).
As of today, the exact triggers of delirium remain largely unknown. Whereas some researchers suggest that delirium should be discussed as a genetically predetermined form of mental inadequateness, others stress out what they consider the indications of this condition being environmentally triggered. During the course of recent decades, however, more and more healthcare professionals were growing to assume an essentially mixed (environmental and genetic) nature of the delirium’s etiology. Nevertheless, the majority of researchers agree, as to what may be considered the foremost risk factors, commonly associated with delirium. In their turn, these factors can be classified as predisposing, on the one hand, and precipitating, on the other. The main predisposing factors include the overall worsening of one’s physical health, visual impairment, alcohol misuse/medical intoxication, male gender, race (Caucasians are more susceptible to delirium), presence of neurological disorders and the lower rate of educational attainment. Precipitating factors include acute fracture, cardiothoracic surgery, blood loss, pre-existing functional impairment, untreated pain and advanced cancer (Farley & McLafferty 2007).
There are also a number of phenomenological aspects to what can be considered the delirium’s discursive significance. For example, it has been noted that the especially acute emanations of this specific form of mental abnormality may well represent a societal danger. That is, individuals in the state of uncontrolled delirium appear to be capable of causing physical injuries to themselves and others. In its turn, this suggests that delirium may be reflective of the innate lack of social empathy in the affected individuals. Because the lack of social empathy is being often regarded as an indication of those who experience it is deprived of a biological vitality, in the evolutionary sense of this word, there is nothing particularly odd about the fact that delirium appears to target predominantly Caucasians. For example, according to Irwin et al. (2008), Caucasians account for 79.8% of all delirious patients in American long-term/hospice care settings. Yet, as the representatives of a distinct racial community, Caucasians also stand on the threshold of extinction – the essence of demographic dynamics in the world validates this statement’s legitimacy. What it means is that the discursive significance of delirium may be discussed as such that is being related to the process of Caucasians finding themselves increasingly incapable to reproduce in sufficient numbers – as opposed to what is being the case with the representatives of racial minorities, for example (Reanne, Redstone & Bo 2010).
In the light of this suggestion, the hypothesis that delirium should be regarded as the biologically predetermined form of a mental illness appears to be not altogether deprived of a certain rationale. Apparently, there are indeed a number of good reasons to draw parallels between the etiology of delirium and the etiology of ageing, for example. After all, ageing is caused by the fact that, at a particular point in time, one’s organism simply refuses (with no apparent reason) to ensure the genetic integrity of the process of his or her body cells being duplicated (Skulachev 2010). The purpose of ageing is death and the purpose of death is freeing the available environmental niches to be occupied by more evolutionary adapted forms of life. Therefore, the fact that delirium (as well as other ‘mysterious’ forms of mental inadequacy, such as autism and Asperger syndrome) seem to ‘prefer’ Caucasians and the fact that even today, this condition’s exact triggering mechanism remains unknown, may suggest that the representatives of this ethnic group have simply fallen out of favor with nature. It is understood, of course, that this suggestion is rather speculative. Still, I believe that it deserves to be considered (Hughey 2010).
The foremost aspect of current treatment methodologies, designed to reduce the acuteness of delirium symptoms, is that their practitioners stress out the importance of the so-called ‘preventive interventions’. These interventions can be discussed in terms of therapeutic strategies, based upon the assumption that physicians should strive to refrain from exposing delirious patients to antipsychotic drugs, for as long as possible, while placing a therapeutic emphasis on prevention rather than on pharmacological treatments. As Attard, Ranjith and Taylor noted, “Preventing delirium is the most effective strategy for reducing both its frequency and the complications associated with this disorder” (2008, p. 634). By definition, preventive interventions are applied on a long-term basis. For example, given the fact that delirium’s most common symptom is disorientation, clinicians are being often concerned with trying to create objective preconditions for patients to never cease experiencing the sensation of an ‘existential wholesomeness’. In its turn, this can be achieved by the mean of encouraging patients to reflect upon what they consider their self-identity. Prompting delirious patients to read newspapers and to watch TV often comes in particularly handy, in this respect, because it helps them to remain in close touch with the surrounding reality – hence, increasing the spatial integrity of their view of themselves. Other, commonly deployed preventive interventions include encouraging patients to take lengthy walks, socialize with other people and pets, and listen to emotionally soothing music.
Nevertheless, because some delirious individuals tend to behave in a rather anti-social manner, physicians are left with no option but to prescribe them antipsychotics and sedatives, which produce short-term beneficiary effects on these individuals’ state of mind. The most commonly prescribed antipsychotic is Haloperidol, which has been proven particularly effective when dealing with the patients’ delirium-driven hyperactivity is being concerned. The other drugs that are being used in the treatment of delirium include Chlorpromazine (which causes heavy sedation), Risperidone (a prolonged application of this particular drug decreases the acuteness of a delirium-driven emotional agitation) and Lorazepam (which reduces the negative effects of an alcohol-withdrawal). In addition, delirious patients have often been prescribed medications for sleep, such as Trazodone and Rozerem (Briskman, Dubinski & Barak 2010).
The main controversy about the practice of prescribing delirious patients with the earlier mentioned medications is the fact that it is being conceptually inconsistent with what should be the actual aim of medical interventions, in the first place – namely, reducing the extent of patients’ cognitive disorientation. This is because, being essentially sedatives, these drugs in fact cause patients to become even more disoriented. This, however, is assumed to be the ‘lesser evil’, as compared to what would be the result of allowing particularly agitated and violently behaving patients to be left on their own (Geffen 2000). The main guidelines, which physicians are expected to observe while subjecting delirious patients to medication-based therapies, are as follows: making sure that patients are not prescribed more than one medication at a time, tailoring the dosage of every particular medication according to the patient’s body size, age and the extent of their agitation’s acuteness and assessing the effects of every medication intake on a daily basis (Tabet & Howard 2009).
I believe that the deployed line of argumentation, in regards to what should be considered the preliminary diagnostic explanation of why Jack acted in the way he did (case scenario), and in regards to what may account for the overall discursive significance of a mental disorder in question, is fully consistent with this paper’s initial thesis. I also think that the analytical insights, regarding delirium’s etiology and treatment, contained in the paper; represent an objective truth-value – even if the provided preliminary diagnosis ends up deemed speculative.
References
Attard, A, Ranjith, G & Taylor, D 2008, ‘Delirium and its treatment’, CNS Drugs, vol. 22 no. 8, pp. 631-644.
Branco, B et al. 2011, ‘Risk factors for delirium in trauma patients: The impact of ethanol use and lack of insurance’, The American Surgeon, vol. 77 no 5, pp. 621-626.
Briskman, I, Dubinski, R & Barak, Y 2010, ‘Treating delirium in a general hospital: A descriptive study of prescribing patterns and outcomes’, International Psychogeriatrics, vol. 22 no. 2, pp. 328-31.
Duppils, S & Wikblad, K 2004, ‘Delirium: Behavioral changes before and during the prodromal phase’, Journal of Clinical Nursing, vol. 13 no. 5, pp. 609-616.
Farley, A & McLafferty, E 2007, ‘Delirium part one: Clinical features, risk factors and assessment’, Nursing Standard, vol. 21 no. 29, pp. 35-40.
Fink, M 1999, ‘Delirious mania’, Bipolar Disorders, vol. 1 no. 1, pp. 54-60.
Geffen, J 2000, ‘Management of acute psychosis’, Australian and New Zealand Journal of Psychiatry, vol 34 no.2, Apr, pp. 339-340.
Gillis, A & MacDonald, B 2006, ‘Unmasking delirium’, The Canadian Nurse, vol. 102 no. 9, pp.18-24.
Hare, M et al. 2008, ‘A questionnaire to determine nurses’ knowledge of delirium and its risk factors’, Contemporary Nurse: A Journal for the Australian Nursing Profession, vol. 29 no.1, pp. 23-31.
Harrow, M et al. 2000, ‘Thought disorder in schizophrenia and mania: Impaired context’, Schizophrenia Bulletin, vol. 26 no. 4, pp. 879-891.
Hughey, M 2010, ‘The (dis)similarities of white racial identities: The conceptual framework of hegemonic whiteness’, Ethnic & Racial Studies, vol. 33 no. 8, pp. 1289-1309.
Irwin, S et al. 2008, ‘Psychiatric issues in palliative care: Recognition of delirium in patients enrolled in hospice care’, Palliative & Supportive Care, vol. 6 no. 2, pp. 159-64.
Karnik, N 2007, ‘Subtypes of pediatric delirium: A treatment algorithm’, Psychosomatics, vol. 48 no. 3, pp. 253-257.
Kiely, D et al. 2007, ‘Association between psychomotor activity delirium subtypes and mortality among newly admitted postacute facility patients’, The Journals of Gerontology, vol. 62 no. 2, pp. 174-179.
Parmet, S, Lynm, C & Glass, R 2004, ‘Delirium’, JAMA: Journal of the American Medical Association, vol. 291 no.14, pp. 1794-1794.
Reanne, F, Redstone, I & Bo, L 2010, ‘Latino immigrants and the U.S. racial order: How and where do they fit in?’, American Sociological Review, vol. 75 no. 3, pp. 378-401.
Schuurmans, M, Duursma, S & Shortridge-Baggett, L 2001, ‘Early recognition of delirium: review of the literature’, Journal of Clinical Nursing, vol. 10 no. 6, pp. 721-729.
Skulachev, V 2010, ‘How to cancel the program of body aging?’, Russian Journal of General Chemistry, vol. 80 no. 7, p1523-1541.
Tabet, N & Howard, R 2009, ‘Pharmacological treatment for the prevention of delirium: Review of current evidence’, International Journal of Geriatric Psychiatry, vol. 24 no.10, pp.1037-1044.