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Clinical Ageing > Delirium > Flashcards

Delirium Flashcards

1
Q

what is delirium?

A

a common serious disturbance in mental abilities that result in confused thinking and reduced awareness of the environment

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2
Q

what are the main symptoms of delirium?

A
  1. inattention - can’t follow
  2. disorganised thinking - rambling, incoherent, not logical
  3. altered state of consciousness
  4. presence of abnormal beliefs - delusions/ hallucinations
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3
Q

what is the cause of delirium?

A

heightened stress response and direct brain insults

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4
Q

what are the risk factors?

A
  1. age (75+)
  2. cognitive impairment
  3. previous history
  4. immobility
  5. visual/ hearing impairments
  6. infection
  7. dehydration
  8. pain
  9. abnormal body temperature
  10. trauma
  11. many medications
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5
Q

what percentage have a single cause?

A

more than 50%

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6
Q

what percentage have no particular cause of delirium

A

10-20%

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7
Q

where is delirium most commonly experienced?

A
  1. most common in palliative care (80%)
  2. nursing home - 20-60%
  3. ICU - (70-87%)
  4. post -operative especially when it is a NOF surgery
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8
Q

how many patients have undetected delirium?

A

30-67%

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9
Q

How is best to avoid a patient experiencing delirium?

A 
keep talking to patient,
assess cog function
communication between staff and family
DO NOT GIVE ANTIDEPRESSANTS if withdrawn
DO NOT GIVE BENZODIAZEPINE if nosiy
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10
Q

does the risk of mortality increase if a case goes undetected?

A

yes - every 48hrs, there is another 11% risk of mortality

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11
Q

how many patients within a week after delirium?

A

1 in 5

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12
Q

what are is the DELIRIUMS ateiology?

A 
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
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13
Q

what drugs cause delirium?

A

sedatives, opioids, antipsychotics, antidepressants, antiparkinsonians, corticosteroid, anti-convulsant, anti-hypertensives, antiarrhythmics, antibiotics

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14
Q

name an example of a sedative

A

benzodizepines

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15
Q

name different anti-parkinson’s drugs

A

anticholinergics, L-dopa, bromocriptine

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16
Q

name anti-hypertensives

A

methyldopa, alpha blcoker and beta blocker

17
Q

why are antibiotics advised against in the treatment of delirium

A

mask the infection, wrong ones may be prescribed and then the infection is not treated and will prolong the symptoms

18
Q

how many patients can recall their delirium experience?

A

54%

19
Q

how many ICU patients who had delirium developed PTSD?

A

27%

20
Q

what is the best and advised pharmacological approach to delirium

A

haloperidol 500mg 2x daily

21
Q

what did a 2005 study find?

A

that 30% of patients acutely admitted onto geriatric wards experienced delirium within 48hrs of being admitted

22
Q

what is the mortality risk of patients with delirium?

A

3-fold mortality risk

23
Q

how fast is the delirium onset?

A

rapid usually a few hours/ a day

24
Q

what core features are affected by delirium?

A

inattention, cognitive impairment, arousal, altered sleep, other changes in mental state

25
Q

how many of acutely admitted older general hospital patients suffer with delirium?

A

20-30%

26
Q

what are direct brain insults?

A

hypotension, hypercapnia, brain haemorrhage, trauma, drugs

27
Q

what is hypercapnia?

A

build up of CO2 in the blood

28
Q

what are aberrant stress responses?

A

aberrations in normally adaptive systemic and CNS

29
Q

for direct brain insults, what does hypoanaemia and systemic hypoglycaemia cause?

A

impairments in attention and cognition

30
Q

in direct brain insults, what does thrombosis and haemorrhage result in?

A

deficits in caudate nucleus/ frontal cholinergic pathways - attention impacted

31
Q

in direct brain insults, what does septic shock result in?

A

extensive white matter damage

32
Q

what does direct brain insults cause?

A

energy deprivation, metabolic disturbances, damage to brain parenchyma, then secondary affects on acetylcholine

33
Q

what is induced by the aberrant stress response?

A

pro-inflammatory cytokines and prostaglandins - sickness behaviour

34
Q

what is sickness behaviour?

A

within aberrant stress response - initiated to conserve energy, minimize exposure to further infection and other stressors

35
Q

what is limbic-hypothalamic-pituitary-adrenal axis?

A

within aberrant stress response - there is sustained levels of cortisol

36
Q

what is hyperactive delirium linked to?

A

hyperglycaemia and increased glucose uptake in the sensory motor cortex

Clinical Ageing (10 decks)

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