[8] Delirium Flashcards
What is delirium?
Delirium is an acute, transient, global organic disorder of CNS functioning, resulting in impaired conciousness and attention
What are the different type of delirium?
- Hypoactive
- Hyperactive
- Mixed
What causes delirium?
Delirium has a number of causes, however most cases are multifactorial
What are the categoies of causes of delirium?
- Hypoxic
- Endocrine
- Infection
- Stroke and other intracranial events
- Nutritional
- Post-operative
- Metabolic
- Abdominal
- Alcohol
- Drugs
- Others
What are the hypoxic causes of delirium?
- Respiratory failure
- Myocardial infarction
- Cardiac failure
- Pulmonary embolism
What are the endocrine causes of delirium?
- Hyperthyroidism
- Hypothyroidism
- Hyperglycaemia
- Hypoglycaemia
- Cushing’s
What are the infectious causes of delirium?
- Pneumonia
- UTI
- Encephalitis
- Meningitis
What are the intracranial causes of delirium?
- Stroke
- Raised ICP
- Intracranial haemorrhage
- Space-occupying lesions
- Head trauma
- Epilepsy
- Intracranial infection
What are the nutritional causes of delirium?
- Thiamine deficiency
- Nicotinic acid deficiency
- Vitamin B12 deficiency
What are the post-operative causes of delirium?
- Anaesthetic
- Opiate analgesics
- Post-operative complications
What are the metabolic causes of delirium?
- Electrolyte disturbance
- Hepatic impairment
- Renal impairment
What are the abdominal causes of delirium?
- Faecal impaction
- Malnutrition
- Urinary retention
- Bladder catheterisation
What are the alcohol-related causes of delirium?
- Intoxication
- Withdrawal
What drugs can cause delirium?
- Benzodiazepines
- Opiods
- Anticholinergic
- Anti-Parkinsonian medications
- Steroids
What are the other causes of delirium?
- Severe pain
- Sensory deprivation, for example leaving the person with spectacles or hearing aids
- Relocation
- Sleep deprivation
What are the risk factors for delirium?
- Hospital admission (delirium occurs in 15-20% of general admissions to hospital)
- Older age (65 or over)
- Multiple co-morbidities
- Dementia (2/3 of cases occur in inpatients with pre-existing dementia)
- Physical frailty
- Renal impairment
- Male sex
- Sensory impairment
- Previous episodes
- Recent surgery
- Severe illness
Describe the course of delirium?
Delirium has an acute onset, and takes a fluctating course, often worse at night
What are the symptoms of delirium?
- Disorganised thinking, e.g. slowed, irrational, or incoherent thoughts
- Euphoric, fearful, depressed, or angry
- Language impaired, e.g. rambling speech, repetitive, disruptive
- Illusions, delusions, and hallucinations
- Reveral of sleep-wake pattern
- Inattention
- Unaware/disorientated
- Memory deficits
What is the common form of delirium?
Hyperactive
What is the problem with diagnosis of hyperactive delirium?
It often goes unrecognised, and can be confused with depression
What are the symptoms of hypoactive delirium?
- Lethargy
- Decreased motor activity
- Apathy
- Sleepiness
What are the symptoms of hyperactive delirium?
- Agitation
- Irritability
- Restlessness
- Aggression
- Hallucinations and delusions may be present
What might hyperactive delirium be confused with?
Functional psychoses
What is the ICD-10 criteria for delirium?
- Impairment of consciousness and attention
- Global disturbance in cognition
- Psychomotor disturbance
- Disturbance of sleep-wake cycle
- Emotional disturbances