Delirium

Question 1

What is delirium?

Answer 1

State of mental confusion that starts suddenly, is acute and can fluctuate

Question 2

Name 3 ways a patient with delirium can present

Answer 2

• Disorientation
• Hallucinations
• Inattention
• Altered level of consciousness
• Memory problems
• Change in mood or personality
• Disturbed sleep

Question 3

What are the 3 types of delirium, and name a symptom that they’re associated with

Answer 3

• Hyperactive delirium: patients may be restless and pace the room. Also anxious, rapid mood swings or hallucinations
• Hypoactive delirium: patients may have reduced activity; being drowsy, sluggish and non-interactive
  Mixed delirium: symptoms that involve both types

Question 4

Name a difference between delirium and dementia

Answer 4

• Dementia often has a slow onset, whereas delirium is typically acute
• The ability to stay focussed is lost in delirium whereas patients in the early stages of dementia aren’t often sluggish or agitated
• Symptoms of dementia typically stay consistent whereas delirium symptoms tend to fluctuate and vary more

Question 5

Name 4 causes of delirium

Answer 5

• Surgery/post GA
• Systemic infection i.e. pneumonia, UTI
• Head injury
• Drugs/drug withdrawal i.e. opiates, levodopa, sedatives, recreational
• Alcohol withdrawal
• Hypoxia (resp or cardiac failure)
• Stroke/MI
• Thiamine, vit B12, nicotinic acid deficiency
• Uraemia
• Dehydration
• Changes of environment
• Hypoglycaemia or hyperglycaemia
• Constipation
• Malnutrition
• Liver failure
• Acute urinary retention
• Pain

Question 6

Name 2 risk factors for delirium

Answer 6

• Having dementia
• Being on multiple drugs
• Older people
• Frail people
• Poor vision and hearing

Question 7

Name 2 aspects of the management of delirium

Answer 7

• Treatment of the underlying cause if possible
• Optimise environmental factors i.e. clock visible
• Haloperidol only in patients who have distressing symptoms that compromises safety