Delirium

Question 1

1. How might you define delirium?

2. identify some of the risk factors for delirium

Answer 1

1. Delirium is an acute deterioration in mental functioning arising over hours or days that is triggered mainly by acute medical illness, surgery, trauma, or drugs
2. Elderly, Pre-existing cognitive impairment, Post-operative, Sensory impairment e.g. deaf/blind, Previous history of delirium, Drug/alcohol dependence, Depression, Polypharmacy
   Multiple co-morbidities (e.g. frailty, Parkinson’s, cerebrovascular disease)
   Intensive care admission

Question 2

1. Name a pneumonic that is helpful for remembering the main causes of delirium.
2. Identify the different parts of this pneumonic.

Answer 2

1. DELIRIUM
2. Drugs
   Electrolyte disturbance
   Lack of drugs (withdrawal)
   Infection
   Reduced sensory input, pain
   Intracranial (stroke, subdural)
   Urinary infection/constipation
   Metabolic disturbance

Question 3

1. Identify some of the main clinical features of delirium

2. What are the two main types of delirium?

Answer 3

1. Sudden onset, short/fluctuating course, hours to month duration, hyperactive or hypoactive, alertness: hypervigilant or lethargic, impaired attention, fluctuating emotions, disorganised thinking, illusions/hallucinations/delusions.
2. Either hyperactive (agitated, aggressive, wandering) or hypoactive (withdrawn, apathetic, sleepy, coma

Question 4

1. All patient’s over 65 are _______ for delirium following hospital admission.
2. What score is used? What is included in it?

Answer 4

1. Screened
2. 4AT score
   (1) Alertness, (2) Age/DOB/Place/year, (3) Attention (months of year backwards), (4) Acute change or fluctuating course

Question 5

1. How is delirium managed?
2. If non-pharmo fails what pharmo treatment is favoured?
3. Capacity should be assessed in delirium patients. Remember that capacity is ______ dependent.

Answer 5

1. Diagnose as delirium, treat the underlying cause, patient-centred non-pharmacological care.
2. Haloperidol 500mg orally, contraindicated in Parkinson’s disease/Lewy body dementia- Lorazepam 500mg in this case.
3. Decsion.