Delirium Flashcards
what is delirium?
a common serious disturbance in mental abilities that result in confused thinking and reduced awareness of the environment
what are the main symptoms of delirium?
- inattention - can’t follow
- disorganised thinking - rambling, incoherent, not logical
- altered state of consciousness
- presence of abnormal beliefs - delusions/ hallucinations
what is the cause of delirium?
heightened stress response and direct brain insults
what are the risk factors?
- age (75+)
- cognitive impairment
- previous history
- immobility
- visual/ hearing impairments
- infection
- dehydration
- pain
- abnormal body temperature
- trauma
- many medications
what percentage have a single cause?
more than 50%
what percentage have no particular cause of delirium
10-20%
where is delirium most commonly experienced?
- most common in palliative care (80%)
- nursing home - 20-60%
- ICU - (70-87%)
- post -operative especially when it is a NOF surgery
how many patients have undetected delirium?
30-67%
How is best to avoid a patient experiencing delirium?
keep talking to patient, assess cog function communication between staff and family DO NOT GIVE ANTIDEPRESSANTS if withdrawn DO NOT GIVE BENZODIAZEPINE if nosiy
does the risk of mortality increase if a case goes undetected?
yes - every 48hrs, there is another 11% risk of mortality
how many patients within a week after delirium?
1 in 5
what are is the DELIRIUMS ateiology?
D - drugs (new and withdrawal) E - environment (eyes and ears) L - low O2, low haemoglobin I - Infection R- retention (stool and urine) I - irritation ( pain and anxiety) U - Under hydrated, under nourished M - metabolic S - stroke and stress
what drugs cause delirium?
sedatives, opioids, antipsychotics, antidepressants, antiparkinsonians, corticosteroid, anti-convulsant, anti-hypertensives, antiarrhythmics, antibiotics
name an example of a sedative
benzodizepines
name different anti-parkinson’s drugs
anticholinergics, L-dopa, bromocriptine
name anti-hypertensives
methyldopa, alpha blcoker and beta blocker
why are antibiotics advised against in the treatment of delirium
mask the infection, wrong ones may be prescribed and then the infection is not treated and will prolong the symptoms
how many patients can recall their delirium experience?
54%
how many ICU patients who had delirium developed PTSD?
27%
what is the best and advised pharmacological approach to delirium
haloperidol 500mg 2x daily
what did a 2005 study find?
that 30% of patients acutely admitted onto geriatric wards experienced delirium within 48hrs of being admitted
what is the mortality risk of patients with delirium?
3-fold mortality risk
how fast is the delirium onset?
rapid usually a few hours/ a day
what core features are affected by delirium?
inattention, cognitive impairment, arousal, altered sleep, other changes in mental state
how many of acutely admitted older general hospital patients suffer with delirium?
20-30%
what are direct brain insults?
hypotension, hypercapnia, brain haemorrhage, trauma, drugs
what is hypercapnia?
build up of CO2 in the blood
what are aberrant stress responses?
aberrations in normally adaptive systemic and CNS
for direct brain insults, what does hypoanaemia and systemic hypoglycaemia cause?
impairments in attention and cognition
in direct brain insults, what does thrombosis and haemorrhage result in?
deficits in caudate nucleus/ frontal cholinergic pathways - attention impacted
in direct brain insults, what does septic shock result in?
extensive white matter damage
what does direct brain insults cause?
energy deprivation, metabolic disturbances, damage to brain parenchyma, then secondary affects on acetylcholine
what is induced by the aberrant stress response?
pro-inflammatory cytokines and prostaglandins - sickness behaviour
what is sickness behaviour?
within aberrant stress response - initiated to conserve energy, minimize exposure to further infection and other stressors
what is limbic-hypothalamic-pituitary-adrenal axis?
within aberrant stress response - there is sustained levels of cortisol
what is hyperactive delirium linked to?
hyperglycaemia and increased glucose uptake in the sensory motor cortex
