Delirium

Question 1

Define delirium

Answer 1

An acute confusional state

Question 2

Risk factors for delirium

Answer 2

>65
Background of dementia 
Significant injury. e.g.hip fracture
Frailty/multi-morbidity
Polypharmacy

Question 3

Precipitating factors for delirium

DELIRIUMS

Answer 3

D - Drugs and Alcohol (Anticholinergics, opiates, anti-convulsants, recreational)

E - Eyes, ears and emotional

L - Low Output state (MI, ARDS, PE, CHF, COPD)

I - Infection

R - Retention (of urine or stool)

I - Ictal

U - Under-hydration/Under-nutrition

M - Metabolic (Electrolyte imbalance, thyroid, Wernicke’s)

(S) - Subdural, Sleep deprivation

Question 4

Factors favouring delirium over dementia

Answer 4

Impairment of consciousness

Fluctuation of symptoms:worse at night, periods of normality

Abnormal perception (e.g. illusions & hallucinations)

Agitation, fear

Delusions

Question 5

Clinical features of delirium

Answer 5

Disorientation

Hallucinations

Inattention

Memory problems

Change in mood/personality

Disturbed sleep

Agitated/withdrawn

Question 6

Investigations for delirium

Answer 6

Full physical exam

Infection screen (obs, FBC, CRP, blood culture, urine dip, sputum & stool sample)

Question 7

Management of delirium

Answer 7

Treat underlying cause

Maintain environment with good lighting

Frequent reassurance

If extremely agitated give haloperidol/olanzapine

Question 8

What antipsychotic would you give an extremely agitated patient with Parkinson’s?

Answer 8

Quetiapine or clozapine

Haloperidol and olanazpine can worsen Parkinsonian symptoms