42. Delirium Flashcards
Clinical presentation of delirium?
disturbance of consciousness with reduced ability to focus or hold attention.
change in cognition or development of a perceptual disturbance (hallucinations, may be frightening)
occurs over short period of time, FLUCTUATES
Risk factors of delirium?
age, pre-existing dementia, medical comorbidity, history of brain injury, history of alcohol abuse, male, sensory impairment, malnourishment, dehydration
what is the Confusion Assessment Method? what does it ask?
- acute onset and fluctuating course?
- inattention
- disorganized thinking
- altered LOC
(must have 1 and 2, plus either 3 or 4)
behavioral treatment of delirium?
use of orienting devices (clocks, calendars, TV)
regular sleep-wake cycle
use of glasses, hearing aids
mobilize patient as soon as possible (gets foley out)
adequate nutrition
pharm treatment for agitation related to delirium?
- haloperidol. has minimal side effect profile compared to antipsychotics.
- atypical antipsychotics (risperidone, olanzapine, Quetapine)
- non-benzo anxiolytics (trazodone, gabapentin), if want to avoid antipsychotics
what symptoms can we see in a state of delirium?
disorientation (common, not required), sleepiness, losing train of thought, hearing things, agitation
may be paranoid delusions
activity level may be increased OR decreased
if we witness someone with visual hallucinations, what kind of disease state should we think of?
medical/neuro problem.
we rarely see visual hallucinations in psych conditions: more AUDITORY hallucinations
signs of hyperactive delirium?
agitation, hyper-arousal, hallucinations, deulsions, can be mistaken for primary psych disorder
may respond to dopamine-blocking agents (haloperidol)
signs of hypoactive delirium?
may be mistaken for depresssion, lethargy, confusion, sedation
the cardinal symptom of delirium is ?
new onset of fluctuation in mental status
T/F: if an extensive medical workup has shown no abnormalities, the diatnosis of a patient with acute mental status change is not likely to be delirium
False.
delirium is a global brain dysfunction based on an underlying condition, whether or not we can find it
generally, what is the treatment strategy for delirium?
treat the underlying medical condition that is causing it.
which neurotransmitters are thought to be involved in the pathophysiology of delirium?
too little dopamine, too much acetylcholine
if you see a focal problem on EEG, is this likely to be delirium?
NO, delirium is generalized.
what classes of meds can cause delirium? (4)
- anticholinergics (delirium is a problem with too much acetylcholine, and these increase acetylcholine)
- opioids
- corticosteroids
- benzodiazepines
