Pathophysiology of delirium

Discussion of the pathogenesis of delirium and acute confusional states, focusing on the reticular activating system.
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[@portchesterkid]

Very useful. Particularly appreciated you explanation of delirium as a symptom of UTI. Observed it, but never understood the mechanism.

[@HealthEdSolutions]

Thanks for your feedback and thank you for watching.

[@ProudMomOne]

I am working on an educational session for nurses on delirium and found this very helpful. Thank you!

[@HealthEdSolutions]

Thank you Jo! Glad it was helpful!

[@ninaramezani4667]

finally i undertand this, thank you!

[@timmothylaplante5816]

I'm not sure how fast I can get a response to this but it's worth a shot. My father was admitted to ICU on June 29th due to a massive stroke. Around July 11th (looking back after doing research) I have realized signs of delirium started setting in. The doctors are just now officially diagnosing him with delirium and they aren't giving us much information on it (according to the doctors delirium is a fairly new research subject but after doing research I don't think that's true). So, essentially I am reaching out to see if I can get some more information. Any links, or "tried and true" research methods for recovery, treatment, etc. would be greatly appreciated. Thank you!

[@THOOODAI]

There isn't really a silver bullet in terms of treatment for delirium, it's usually to treat the underlying cause (because delirium itself isn't a disease it's really a group of symptoms). If your father is still in a confused/disoriented state since July 11th then it may be more related to dementia or a neurocognitive disorder. Since he has a history of stroke that could also play a role and a space-occupying lesion could be the cause. Just suggestions though, I'm a med student haha. Best of luck with your dad's recovery.

[@HealthEdSolutions]

Thanks for the question. We will ask Dr. Wolf and see what he says!

[@HealthEdSolutions]

@@THOOODAI Thanks for your input!

[@katiforbes1194]

5:40->Could you explain how the vagal reflex cause anticholinergic activity with UTIs? I'm trying to figure out the pathophysiology for delirium with UTIs in elderly (I'm a 3rd yr pharm student). I thought activation of the vagus nerve would increase the parasympathetic response (inc cholinergic activity) sort of like vasovagal syncope (M3 activation leading to vasodilation and M2 dec HR, not sure of the cause of inc parasympathetic response with this either)

[@HealthEdSolutions]

Thanks for the question Kati. We've passed it along to Dr. Wolf and will reply when we get his feedback:)

[@thepseudodr1813]

You mentioned the pons and the medulla, and subsequently said "other places as well", which include the brainstem. Pons + medulla are in the brainstem so I'm not entirely sure what you meant (perhaps the midbrain?).

[@HealthEdSolutions]

Thanks for the question. We will ask Dr. Wolf and see what he says!

[@svadhishthana]

I heard it can last up to months, in specific people charcterize by fearful to horific halucinations. Not very nice at all.

[@HealthEdSolutions]

Thanks for the input Christian and thanks for watching!

[@bigphizza2819]

Most informative, even for a non-medical person like me:)

[@HealthEdSolutions]

Awesome to hear!

[@88SilverBird88]

Thank you for these videos Andrew. I was just wondering what do you use to write the notes on the PC?

[@HealthEdSolutions]

Thanks so much! A Wacom tablet :)

[@WDBsirLocksight]

Great video! Now I can research more on the Reticulated Activating System. Dang what permutations exist to comb back through the research I've read (4 stacks, 200 papers)..? 5 MESH x 5 Disorders × 5 modalities x 5 specialties x 20 institutions...... Unfortunately I think I have delirium. Another unfortunate thing, many entities or profiles overlap, so maybe I dont. So how would one conceptualize somebody with ASD/OCD/ADHD and/or hormonal disorder and/or autistic catatonia....? I dont mean it as a trap question but it kinda is. The same differential you use for ASD and psychosis, could be the same for these others. Unfortunately many providers have never done a differential like the above. And as we know medical, neuro and psychiatry don't work together. Great if the physiatrist in your area will do a wholistic assessment but in some jurisdictions they only work with muskoskeletal. So you go to 5-8 different doctors, 10-16 if second opinion per year. This is quite common for individuals with rare genetic disorders. I have lived experience of the above. I just hope it doesn't get more than it is less.

[@HealthEdSolutions]

Thanks for sharing your thoughts!

[@WDBsirLocksight]

@@HealthEdSolutions Dang ur up late. Some charting perhaps...?

[@WDBsirLocksight]

So interesting stuff I found: "The RAS orchestrates the transition from sleep to wakefulness, by promoting the creation of gamma band (20-40 Hz) waves and suppressing slow waves in the brain, like the spindle wave oscillations (11-14 Hz), delta waves (1-4 Hz), and slow waves in the cortex (0.3-1 Hz). " "If it weren’t for this circuitry, our consciousness would be overwhelmed and flooded with all sensory information, leading to an inability to make decisions" bodytomy.com/reticular-activating-system Couldn't be a stretch to understand some sort of influence on melatonin and oxytocin, as well. There 5 experiments there with the EEG. mmm.... Gamma Band Disorder... mmm... The trigeminal nerve is a major input into the brain stem (reticular activating system) which controls activity level of the brain. I wonder if sensory processing disorder has any correlation to RAS; or being overwhelmed by certain events as one processes it, such as happening down south. The best I found in the context of SPD (www.keystonensc.com/downloads/epa-sensory-integration.pdf). www.meaningfulhq.com/reticular-activating-system-function.html I guess BCI as neuro-orthotic takes advantage of some part of RAS, as well as focusing hard to blow up things (ref Accepted movie). It regulates ATCH too (www.sciencedirect.com/science/article/pii/0006899369902844). Recent Summ (2016): journals.sagepub.com/doi/pdf/10.18679/CN11-6030_R.2016.034 I think it will take some searching to find relevant papers (above was 30mins). Another lived-experience individual (nice layout) mybiohack.com/blog/control-reticular-activating-system-ras I'm cautious with biohackung because I don't subscribe to cyborgs as the singularity.

[@munamunam]

your awesome! thank you

[@HealthEdSolutions]

Thanks so much!

[@rachk8255]

Thank you :)..

[@HealthEdSolutions]

You're welcome! :)

[@emilydumas3131]

Can empty sella syndrome potentially cause delerium?

[@xrggn]

Thanks doc.

[@HealthEdSolutions]

You're welcome and thanks for watching!

[@tyoung8280]

It's not transient if it isn't treated. - can last months or even years.

[@HealthEdSolutions]

Thanks for your input!

[@ruischp]

Where can i find a paper on this?

[@HealthEdSolutions]

We will be releasing it soon on the www.healthedsolutions.com website. Thanks for watching!

[@vidyashreejanamatti8192]

Dat aa aa was irritating

[@HealthEdSolutions]

Thanks for watching and the feedback is appreciated :)

[@roshaniverma2999]

In hindi