Delirium

Question 1

What is delirium?

Answer 1

Acute, transient disorder of CNS functioning resulting in impaired consciousness and attention

Question 2

What are the types of delirium?

Answer 2

Hypoactive
Hyperactive
Mixed

Question 3

What are the features of hypoactive delirium?

Answer 3

Lethargy
Decreased motor activity
Apathy
Sleepiness

Often gets confused with depression

Question 4

What are the features of hyperactive delirium?

Answer 4

Agitation 
Irritability
Restlessness
Aggression
\+/- hallucinations
\+/- delusions

Question 5

What are the features of mixed delirium?

Answer 5

Features of both hypoactive and hyperactive delirium

Question 6

What are risk factors for delirium?

Answer 6

> 65
Dementia
Frailty
Sensory impairment
Previous delirium

Question 7

What are causes of delirium?

Answer 7

Hypoxia
Endocrine disturbances
Infection
Pain
Sensory deprivation
Electrolyte abnormalities
Constipation
Urinary retention
Alcohol/drugs

Question 8

What is the pneumonic for clinical features of delirium?

Answer 8

DELIRIUM

Question 9

What are the clinical features of delirium?

Answer 9

Disordered thinking
Euphoric, angry, depressed
Language impaired
Illusions, delusions, hallucinations
Reversal of sleep wake cycle
Inattention
Unaware
Memory deficits

Question 10

What are the ICD-10 criteria for delirium?

Answer 10

Impairment of consciousness + attention
Global disturbance in cognition
Psychomotor disturbance
Disturbance of sleep wake cycle
Emotional disturbances

Question 11

What investigations are done for suspected delirium?

Answer 11

Cognition screen

• AMTS
• CAM

Urinalysis

Bloods - FBC, U&Es, CRP, glucose, TFTs, B12, folate

CXR

Abdo exam + PR

Question 12

How is delirium managed?

Answer 12

Treat underlying cause

Reassure + reorientate

• avoid moving
• provide clocks

Appropriate environment

• quiet side room
• well lit
• provide sensory aids as required