delirium

Question 1

what are predisposing factors for delirium?

Answer 1

age > 65 years
background of dementia
significant injury e.g. hip fracture
frailty or multimorbidity
polypharmacy

Question 2

what are possible causes of delirium?

Answer 2

infection: particularly urinary tract infections
metabolic: e.g. hypercalcaemia, hypoglycaemia, hyperglycaemia, dehydration
change of environment
any significant cardiovascular, respiratory, neurological or endocrine condition
severe pain
alcohol withdrawal
constipation

Question 3

what are features of delirium?

Answer 3

memory disturbances (loss of short term > long term)
may be very agitated or withdrawn
disorientation
mood change
visual hallucinations
disturbed sleep cycle
poor attention

Question 4

what is the management of delirium?

Answer 4

rx underlying cause
modify environment
1st line sedative - haloperidol 0.5mg
or olanzapine

if PD- careful reduction in parkinsons meds can be helpful; atypical antipsychotics quetiapine /clozapine preferred

Question 5

what factors favour delirium over dementia?

Answer 5

acute onset
impairment of consciousness
fluctuation of symptoms: worse at night, periods of normality
abnormal perception (e.g. illusions and hallucinations)
agitation, fear
delusions