Delirium

Question 1

Big 6 predisposing factors of delirium

Answer 1

Cognitive impairment
Sleep deprivation
Immobility
Visual impairment
Hearing impairment
Dehydration

Question 2

According to ccsmh, when are you allowed to use restraints in delirium

Answer 2

-“exceptional circumstances” such as
-serious risk of bodily harm to self or others
-other means of controlling behaviour have been explored first, including meds, but were ineffective
-benefits outweigh the risks

Question 3

Subtle manifestations of delirium

Answer 3

-restlessness
-anxiety/irritability/mood or affective lability
-hypersensitive/hyper vigilant
-nightmares
-new onset urinary incontinence
Unsteady gait/falls
Dysarthria or word finding difficulty

Question 4

As per ccsmh delirium, RF for longer duration

Answer 4

-pre existing dementia
-multiple morbidities
-higher delirium severity
-hypoactive symptoms
-hypoxia

Question 5

Why haldol over other antipsychotics according to ccsmh guidelines for delirium

Answer 5

-oral and parenteral route
-less anticholibergic
-less orthostasis

Question 6

Features of delirium that predict worse outcomes

Answer 6

-hypoactive
-older age
-frailty
-delirium duration
-delirium severity

Question 7

Components of multi component interventions for prevention of delirium

Answer 7

• examples include HELP
  Address visual and hearing impairment
  Immobility
  Disorientation
  Sleep deprivation
  Dehydration
  Hypoxia
  Infection
  Pain
  Constipation

Question 8

GMC vs alcohol withdrawal delirium

Answer 8

Varying time course vs 48-96 hours
EEG shows diffuse slow wave vs diffuse fast wave
-“picking at the air” vs tremor
-nothing vs autonomic instability/N/V
-antipsychotics vs benzos
- nothing vs hallucinations in different sensory modalities

Question 9

Cns toxicity vs delirium GMC

Answer 9

In antibiotics
Will get myoclonus, and eventually seizure!!!unusual in delirium
Consider EEG
Treat with benzos!!