Dr. Sanjeev Sockalingam
Dr. Sanjeev Sockalingam, with Medical Psychiatry Fellow Michael Hawkins, says checking in with patients and families to identify signs of delirium early is critical. (Photo: Hau Dinh)

As part of Delirium Awareness Week at UHN, we asked Dr. Sanjeev Sockalingam, Deputy Psychiatrist-in-Chief (Toronto General and Princess Margaret) and Director of the Bariatric Surgery Psychosocial Program, to reflect on how delirium affects patients.

Delirium is one of the most pervasive patient health issues across all UHN sites, with an episode occurring almost daily. Its treatment often requires a multi-disciplinary approach. Although many patients will fully recover from their experience with delirium, some may continue to face its effects years later.

Dr. Sockaligam recalls seeing a patient shortly following her liver transplant who began to show signs of delirium while in the ICU. She was restless, agitated and difficult to engage.

Delirium can happen to anyone, anywhere, but it often happens when someone is in the hospital. It is categorized as a medical emergency as it can be a risk to patient safety.

The ​patient's care team swiftly recognized the signs and were able to identify both pharmaceutical and non-pharmaceutical options for treatment.

What is delirium?

Delirium [dih-leer-ee-uhm] is a condition that causes a person to become confused in their thinking. It is a physical problem (a change in the body) that can lead to a temporary change in thinking. Delirium usually starts over a few days and often gets better with treatment.

Her delirium episode was resolved within a week, however, Dr. Sockalingam says years later the patient continues to remember pieces of her delirium episode and expressed significant distress about that time. This illustrates the lasting effects delirium may have on patients. 

"In keeping with Caring Safely, early identification and intervention is critical to putting patients and families first," says Dr. Sockalingam.

"The length of episodes often depends on how well we identify and treat. If we can correct those causes swiftly, it can usually resolve within days to a couple of weeks. Early identification, prevention and intervention is critical."

It is crucial for staff to be trained on how to identify symptoms of delirium and are equipped to treat it at the bedside.

During Delirium Awareness Week, UHN will be hosting a Grand Round and staff competition to promote delirium awareness and prevention, and all Patient and Family Education libraries will display useful materials for patients and families.

What does delirium look like?

Delirium makes it hard for a person to pay attention or concentrate. Some signs might be:

  • trouble understanding what is happening around them
  • saying things that do not make sense
  • seeing or hearing things that are not really there
  • feeling afraid that people are trying to harm them​

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