Delirium

Question 1

What is delirium?

Answer 1

Delirium is a serious disturbance in mental abilities that results in confused thinking and reduced awareness of the environment.

The start of delirium is usually rapid — within hours or a few days. It is the most common psychosis seen in the general hospital setting, where it occurs in 14–24% of patients

Question 2

How common is delirium?

Answer 2

It is the most common psychosis seen in the general hospital setting, where it occurs in 14–24% of patients. This rises in specialist populations such as intensive care (70–87%)

Question 3

What are risk factors for delirium?

Answer 3

Extreme age
Damaged brain (stroke, dementia, injury, alcoholic damage)
Unfamiliar environment
Sleep deprivation
Sensory overload

Question 4

What drugs can trigger delirium?

Answer 4

• Sleep medication
• Pain medication
• Asthma and allergy medications
• Corticosteroids

Question 5

What are the causes for delirium?

Answer 5

Systemic infection (especially with fever)

Metabolic disturbances

Vitamin deficiency

Endocrine disease

Brain trauma, tumour, abscess, subarachnoid haemorrhage

Drugs

Withdrawal

Postoperative states

Question 6

What is the clinical presentation for delirium?

Answer 6

Signs and symptoms of delirium usually begin over a few hours or a few days. They often fluctuate throughout the day, and there may be periods of no symptoms.

1. Reduced awareness of the environment
2. Cognitive Impairment
3. Behavioural changes
4. Emotional disturbances

Question 7

When are delirium symptoms worst?

Answer 7

Night

Question 8

What are the different types of delirium?

Answer 8

1. Hyperactive
2. Hypoactive
3. Mixed delirium

Question 9

What characterises hyperactive delirium?

Answer 9

Probably the most easily recognised type, this may include restlessness (for example, pacing), agitation, rapid mood changes or hallucinations, and refusal to cooperate with care.

Question 10

What characterises hypoactive delirium?

Answer 10

This may include inactivity or reduced motor activity, sluggishness, abnormal drowsiness, or seeming to be in a daze.

Question 11

What characterises mixed delirium?

Answer 11

• This includes both hyperactive and hypoactive signs and symptoms.
• The person may quickly switch back and forth from hyperactive to hypoactive states.

Question 12

How is delirium diagnosed?

Answer 12

1. Disturbance of consciousness (less clarity of awareness of the environment, less ability to focus and sustain attention)
2. Change in cognition (memory deficit, disorientation, language disturbance)
3. Disturbance develops over a short period
4. Fluctuation over the course of a day

Question 13

How would you manage delirium?

Answer 13

Treatment of the underlying disease

The patient should be carefully nursed and rehydrated in a quiet single room with a window that does not allow exits

All current drug therapy should be reviewed and, where possible, stopped

Question 14

What medication can help in severe delirium?

Answer 14

Haloperidol

Olanzapine is an effective alternative, especially if given at night for insomnia.

Benzodiazepines should not be used as first-line medication and may prolong confusion

Question 15

How would you prevent delirium?

Answer 15

The most successful approach to preventing delirium is to target risk factors that might trigger an episode

Promoting good sleep habits, helping the person remain calm and well-oriented, and helping prevent medical problems or other complications can help prev

Question 16

What is the prognosis for delirium?

Answer 16

Delirium usually clears within a week or two, but brain recovery usually lags behind the recovery from the causative physical illness.

• Some 25% of the elderly with delirium will have underlying dementia
• 15% of patients do not survive their underlying illness
• 40% are in institutional care at 6 months.