confusion

Question 1

DSM-5 definition of delirium

Answer 1

Disturbance in attention (i.e., reduced ability to direct, focus, sustain, and shift attention) and awareness (reduced orientation to the environment). develops over a short period of time (usually hours to a few days), represents change from baseline attention/awareness, and tends to fluctuate during course of a day

Question 2

Delirium clinical characteristics

Answer 2

Fluctuating arousal, Attention Deficits: Digit span (normal 7 +/- 1), Alterations in memory, language, constructions, perceptions and mood, Spontaneous speech may be incoherent, rambling, shifting topics

Question 3

Delirium management

Answer 3

Low dose Haldol; remember IV form, May use low dose atypicals if PO, Donepezil, Unless EtOH withdrawal, avoid pitfalls of benzos and paradoxical agitation, Physical restraints only during acute agitation and promptly removed

Question 4

Delirium impairment

Answer 4

bottom up : loss of arousal > attention > language > memory > praxis > agnosia > executive function

Question 5

Dementia impairment

Answer 5

top down: executive function > agnosia > praxis > memory > language > attention > arousal (arousal and attention usually normal)