Delirium

Question 1

What is delirium?

Answer 1

Acute confusional state

Question 2

What are the 5 DSM V features of delirium?

Answer 2

A - disturbance in attention and awareness
B - disturbance develops over SHORT period of time, represents a change from baseline attention/awareness, and tends to fluctuate in severity during the course of the day (tends to be worse at night)
C - an additional disturbance in cognition (memory/disorientation/language/visuospatial)
D - disturbances in A and C are not better explained by another mental disorder and don’t occur in the context of REDUCED arousal
E - there is evidence from the history, physical examination of a cause

Question 3

What are the causes of delirium?

Answer 3

Infection
Change in environment
Medication (opiates, anticholinergics, steroids)
Alcohol withdrawal
Surgery
Pain
Liver/renal impairment
Hypoxia
Hyponatraemia
Stroke
Encephalitis
Constipation
Urine retention
Dehydration

Question 4

What are the 2 types of delirium?

Answer 4

Hyperactive

Hypoactive

Question 5

What is delirium tremens?

Answer 5

Alcohol withdrawal syndrome

48-72 hour grace period then explosive delirium

Question 6

What are the predisposing factors for delirium?

Answer 6

Advanced age
Dementia
Impaired activities of daily living
Immobility
Sensory
others
Alcohol

Question 7

How is delirium managed?

Answer 7

Anticipate - modify risk factors
Diagnose early - involve liaison team if not clear-cut and exclude underlying dementia
Treat the cause
Medication - avoid anticholinergics, potentially low-dose antipsychotics or benzos if desperate
Good nursing - single room, well lit, familiar staff