complications of physical disorders (delirium) Flashcards
what can the causes of confusion be divided into?
-Transient causes
-Enduring causes
what does a transient cause of confusion mean?
A confusional state that is likely to recover the following resolution/elimination of the underlying cause
examples of transient causes of confusion?
Delirium
Post-ictal confusion
Migraine
Delirium tremens
Physical ill-health and chronic illness.
Intoxication – covered in substance misuse session
Medications
what is another name for an acute confusional state?
delirium
what are the 3 most common types of delirium?
Hypoactive
Hyperactive
Mixed
describe patient with hypoactive delirium
Hypoactive- quiet, confused, drowsy, fearful patient
describe a patient with hyperactive delirium
Hyperactive- driven, wandering, agitated, shouting out and often aggressive
describe a patient with mixed delirium
Hypoactive- quiet, confused, drowsy, fearful patient
Hyperactive- driven, wandering, agitated, shouting out and often aggressive
Mixed- some periods of both of the above
who most commonly gets delirium?
-Associated with a physical insult or injury or environmental factors
-Older people
-Those with previous history of delirium and those with underlying cognitive deficits are more vulnerable
Presentation of delirium?
Duration of delirium varies but often continues beyond the resolution of the original insult- often by weeks or months
-Rapid onset (1-2 days from precipitating insult)
-Disorientation, time, place, person
-Fluctuating confusion, diurnal variation evening and night often worse than day time
- Agitation and distress
- Inattention
- Auditory or visual hallucinations – often vivid.
- Patients may be aggressive as a result of fear and confusion
treatment of delirium?
Treat underlying cause
* Reassurance and reorientation
* Low stimulus environment
* Assistance with activities of daily living during recovery
* Assistance with medications
* Use of appropriate legal measures (adults with incapacity, mental capacity act, vulnerable adult measures) to allow for treatment
- Pharmacological interventions to assist with distress, agitation and aggression. Not a cure but a supportive therapy. Consider low dose antipsychotic medications (Haloperidol, Quetiapine, Olanzapine) targeted to the timing of concerning symptoms.
complications of delirium?
35-40% patients die within one year of episode of delirium
what is Post-Ictal confusion?
-Abnormal condition following a seizure
-Begins when the seizure ends and ends when the patient has returned to baseline. Usually resolves within 30mins but can last for hours or days.
when does post-ictal confusion start/ end?
-begins when the seizure ends
-ends when the patient has returned to baseline
how long does it usually take for post-ictal confusion to resolve?
usually resolves within 30 mins but can last hours or days
presentation of post- ictal confusion?
-drowsiness
-nausea
-confusion
-exhaustion
management of post-ictal confusion?
supportive management and health promotion in the form of seizure prevention
4 phases of migraine headache?
-Prodrome
-Aura
-Headache
-Postdrome
what are delirium tremors due to?
severe alcohol withdrawal
presentation of delirium tremors?
Auditory hallucinations
Visual hallucinations - often of insects of tiny things (e.g. ants, spiders, tiny people)
Tactile hallucinations – things crawling on the skin
Confusion
Disorientation
Sweating
High blood pressure
treatment for delirium tremors?
-benzodiazepines
-consider fluid, electrolyte and vitamin replacement
complications of delirium tremors?
-delirium tremors can be fatal due to high risk of seizures
physical ill health and chronic illnesses that cause delirium?
-Encephalitis
-Hypoglycaemia
-Hypothyroidism/ hyperthyroidism
-Vit B12 deficiency
-Anaemia
-Electrolyte disturbances
Medications that cause delirium?
-Analgesics (espcecially opioid medication and gabapentinoids)
-Steroids
-Benzodiazepines
-Narcotis (zopiclone, zolpidem)
-NSAIDs
-H2 receptor antagonists (digoxin, beta blockers)
Enduring causes of delirium?
-Aquired brain injury
-Dementia (Alzheimer’s disease, Vasculr dementia, mixed presentations)
-Alcohol related dementia
most common subtype of dementia?
Alzheimer’s
what type of memory is typically affected in Alzheimers?
short term= impaired
long term= usually preserved
findings on CT of Alzheimers?
atrophy most notable in the temporal lobe
treatment for Alzheimers?
progression can be slowed but not ceased with Acetylcholinesterase Inhibitors (e.g. Donepezil, Galantamine)
what is vascular dementia caused by?
caused by impaired blood flow to the brain leading to chronic vascular injury/ TIAs or stroke events
what does a CT of someone with vascular dementia show?
a pattern of small vessel disease or stroke
what is alcohol related dementia?
Neuronal damage secondary to long term, excessive alcohol consumption. Predominantly affects the frontal lobes
Severe end of a spectrum of disorders collectively names Alcohol related brain Injuries (ARBI)
can alcohol related brain injuries be reversed?
yes- if a patient remains abstinent from alcohol for 9-12 months
is codeine a good drug to use for a patient with delirium?
no
