Virtual Medical Centre

Symptoms

Agitation and confusion

• Definition
• Causes

Definitions:

Confusion:

Confusion is characterised by disorientation with regards to time, place and person. There may also be impaired consciousness (i.e. the patient may be drowsy). In many cases confusion is due to more than one cause.

Delirium:

Delirium is defined as a recent onset confusional state in a previously non confused individual. In normal practice, it is generally reversible on treating the cause. In patients with cancer, there are often multiple causes of the delirium, some of which may be reversible, some of which may not. Delirium that occurs in the last few days of life is often referred to as terminal confusion/delirium. Often medications, such as painkillers are blamed for a patient's confusion; however they should not be stopped without careful consideration - patients who are confused can still feel pain, and the importance of continuing painkillers cannot be stressed enough. If someone has been taking morphine without any problems for a significant period of time, it is very unlikely that morphine will be to blame if confusion subsequently develops later in the illness.

Agitation:

A state of chronic restlessness and physical activity associated with mental disturbance. Sometimes this is associated with dilated pupils, sweating and a fast heart rate.

Terminal Restlessness:

This is a delirium or acute confusional state that commonly occurs in the last few days of life. It is usually associated with agitation, restlessness, disorientation and impaired consciousness. Hallucinations, aggression, twitching, and moaning and groaning sometimes occur.

Causes

There are a number of possible causes in the development of an acute confusional state or delirium. Delirium can develop over hours or days and may fluctuate in intensity.

Some general causes include:

• Problems within the brain: Tumour, bleeding, infection, epileptic seizures.
• Disturbances of blood chemistry: Low oxygen levels in the blood, liver or kidney failure, blood chemistry disorders eg. low sodium levels, high calcium levels.
• Glandular disorders: High or low blood sugar, thyroid problems.
• Infection/Fever
• Drugs: Alcohol, anticonvulsants, antidepressants, some chemotherapy drugs, anti- nausea drugs, antihistamines, anticholinergics, antiparkinsonian agents, antipsychotics, sedatives, corticosteroids, strong painkillers and stimulants (amphetamine, cocaine).
• Drug Withdrawal: Alcohol, barbiturates, nicotine, opioids, 'benzos' (Valium-like drugs).
• Dehydration or anaemia.
• Contributing and Precipitating Factors: Anxiety, fear, depression, pain, urinary retention, pre existing brain disease, sleep deprivation, altered environment.

In the case of terminal restlessness or agitation, a search for an exact cause is often unfruitful. In some ways, it is a diagnosis of exclusion. The reason why these symptoms occur is currently unknown. Recent work has focused on the role of chemicals made by tumours which can have effects on the workings of the brain. Certain cancers, such as a particular form of lung cancer, are known to secrete substances that work against brain cells. It may be shown in the future that other diseases such prostate cancer also have the similar effects.