Delerium

Question 1

What is delirium?

Answer 1

A disturbance in attention, change in cognition

Question 2

Is delirium acute or chronic?

Answer 2

Acute - comes on over short period

Question 3

Causes of delirium?

Answer 3

Direct consequence of medical condition
Intoxicating substance
Medication use

Question 4

Predisposing factors to delirium?

Answer 4

Advancing age
Preexisting dementia 
Comorbidity
Post operative period 
Terminal illness
Sensory impairment 
Polypharmacy 
Depression 
Alcohol dependency 
Malnutrition

Question 5

What are the main features of delirium ?

Answer 5

Acute and fluctuating
Inattention
Altered level of consciousness
Disorganised thinking

Question 6

What are the subtypes of delirium?

Answer 6

Hyperactive

Hypoactive

Question 7

Is hypo or hyperactive delirium more common?

Answer 7

Hypoactive

Question 8

Features of hyperactive delirium?

Answer 8

Agitated
Aggressive
Wandering
Early to diagnose

Question 9

Features of hypo active delirium?

Answer 9

Withdrawn
Apathetic
Sleepy
Coma

Easily missed
Higher mortality risk than with hyperactive

Question 10

What test can be done in delirium?

Answer 10

4AT

Question 11

What happens in 4AT?

Answer 11

Alertness
AMT4 - age, DOB, Place, year
Attention
Acute change or fluctuating course

Question 12

What does each section of 4AT weigh?

Answer 12

Alertness - normal =0, clearly abnormal =4
AMT4 - age, DOB, place, year - no mistakes=0, 1 mistake =1, >2 mistakes =2
Attention -0-2
Acute change or fluctuation course - no=0, yes =4

Question 13

Management of delirium?

Answer 13

Identify and reverse underlying causes
Symptoms control
Clinical review and follow up
Try not to use pharmacological measures

Question 14

What pharmacological measures can be used in delirium?

Answer 14

Sedation only if risk to self and others
Haloperidol
benzodiazepines
Quetiapine