Acute confusional state Flashcards
What is another term for Acute Confusional State?
Delirium or Acute Organic Brain Syndrome.
What percentage of elderly patients admitted to the hospital are affected by acute confusional state (delirium)?
Up to 30%.
List some predisposing factors for acute confusional state.
- Age > 65 years
- Background of dementia
- Significant injury (e.g., hip fracture)
- Frailty or multimorbidity
- Polypharmacy
What are some common precipitating events for delirium?
- Infection (especially urinary tract infections)
- Metabolic disturbances (e.g., hypercalcaemia, hypoglycaemia, hyperglycaemia, dehydration)
- Change of environment
- Cardiovascular, respiratory, neurological, or endocrine conditions
- Severe pain
- Alcohol withdrawal
- Constipation
What are the key features of acute confusional state?
- Memory disturbances (short-term > long-term)
- Agitation or withdrawal
- Disorientation
- Mood changes
- Visual hallucinations
- Disturbed sleep cycle
- Poor attention
How should acute confusional state be managed?
- Treatment of the underlying cause
- Modification of the environment
What is the first-line pharmacological treatment for acute confusional state (delirium) if no Parkinson’s disease is present?
Haloperidol 0.5 mg.
What does the 2010 NICE delirium guidelines recommend for treatment?
Haloperidol or olanzapine (note that olanzapine is no longer recommended).
What is the preferred pharmacological treatment for delirium in patients with Parkinson’s disease?
A: Lorazepam (if urgent treatment is required) or an atypical antipsychotic (e.g., quetiapine, clozapine).
How should Parkinson’s disease medication be managed in delirium?
A careful reduction of Parkinson’s medication may be helpful
Q: What factors favour a diagnosis of delirium over dementia?
- Acute onset
- Impairment of consciousness
- Fluctuation of symptoms (worse at night, periods of normality)
- Abnormal perception (e.g., illusions and hallucinations)
- Agitation and fear
- Delusions
