Delirium Flashcards
What is the most common mental health problem in hospitalised patients over 65 years?
Delirium
What is the definition of delirium?
Acute deterioration in mental functioning arising over hours or days that is triggered mainly by acute medical illness, surgery, trauma, or drugs.
What are some causes of delirium?
Drugs (eg anticholinergics, anticonvulsants, alcohol, illicit drugs)
Withdrawal (eg alcohol, sedatives)
Metabolic (eg hypoglycaemia, hypothyroid, B12/folate, calcium)
Electrolyte disturbance (eg hyponatraemia)
Infection
Head trauma
Epilepsy
Reduced sensory input, pain
Urinary retention/constipation
Neoplastic diseases
Vascular disorders
What are some risk factors for delirium?
Elderly
Pre-existing cognitive impairment
Perioperative
Immobility
Social isolation
Sensory deficits/extremes
Drug/alcohol dependence
New environment
Stress
Depression
Polypharmacy
Intensive care admission
Multiple co-morbidities
What is the pathophysiology behind delirium?
Not well understood
Derangement of neurotransmitters (particularly ACh)
Direct toxic insult to brain
Aberrant stress responses (eg cortisol, prostaglandins, cytokines)
What are some clinical features of delirium?
Rapid onset
Transient and fluctuating course (lasting days to months)
Inattention/decreased awareness
Hyperactive or hypoactive
Often particularly at night
What are some investigations for delirium?
Screening tools (4-AT)
Medication review
Bloods (FBC, U+Es, LFTs, calcium, B12/folate, Mg, TSH, glucose, cultures)
ECG
Imaging (eg bladder scan, CT head)
Specialist tests (eg EEG, LP)
What are the diagnostic criteria for delirium?
Impairment of consciousness
Disturbance of cognition
Psychomotor disturbance
Disturbance of sleep-wake cycle
Emotional disturbance
What is the management of delirium?
Identify and treat cause
Manage environment and provide support
Food chart, fluid chart, bowel chart
Where non-medical methods have failed:
- 1st line- haloperidol 500mcg orally (NOT IN PARKINSON’S OR LBD)
- Lorazepam 500mcg-1mg orally if haloperidol contraindicated
- Benzos if alcohol/sedative withdrawal
