Delirium

Question 1

what is delirium

Answer 1

syndrome of acute cognitive impairment, of ten precipitated by illness or surgery
affects ~25% of all in-hospital patients

Question 2

features of delirium

Answer 2

acute - changes over hours to days that fluctuate over time
cognitive impairment
psychiatric disturbance
psychomotor patterns

Question 3

describe the cognitive impairment experienced in delirium

Answer 3

attentional impairment
disorientation to location and time
short and long-term memory loss

Question 4

describe the psychiatric disturbance experienced in delirium

Answer 4

anxiety and agitation (sometimes violent)
visual and auditory hallucinations
delusions

Question 5

what are the psychomotor patterns of delirium

Answer 5

hyperactive - agitated, restless, violent
hypoactive - drowsy, sedation, lethargy, easily missed

Question 6

causes of delirium

Answer 6

often multifactorial and precipitated by significant risk factors

Question 7

what are the pre-existing risk factors for delirium

Answer 7

frailty
previous delirium
dementia and cognitive impairment
psychiatric disorder
polypharmacy
alcohol and substance abuse
isolation
social deprivation

Question 8

what acute insults may lead to delirium

Answer 8

infection (stereotype of UTI)
surgery
hospitilisation
institutionalisation
bowel and bladder
dehydration
medication
sleep deprivation
sensory impairment

Question 9

what is the connection between dementia and delirium

Answer 9

significant risk factor fot=r delirium
delirium is also a significant risk factor for subsequent dementia
people with dementia who suffer from delirium may struggle to fully recover

Question 10

clinical assessment for delirium

Answer 10

recognition - screening tools (4AT), stabdard of care for older adults admitted to hospital
diagnosis and investigation of underlying causes
full history and examination
baseline function
delirium screen investigations
medication review

Question 11

clinical management of delirium

Answer 11

prevention is the best management
immediate treatment - standard acute assessment, reassurance, consider safety (staff and patient), emergency detention under mental health may be necessary to protect the patient

Question 12

treatment of delirium

Answer 12

comprehensive and systematic assessment of potential precipitating factors
speciality involvement
treat specific underlying cause or risk factor
use non-pharmacological interventions to reduce the incidence