Delirium

Question 1

What is delirium?

Answer 1

An acute, fluctuating mental status, with inattention, disorganised thinking and altertered levels of consciousness

Question 2

What are the four features of delirium?

Answer 2

A change in cognition
A disturbance in attention
Disturbance develops over a short period of time
Evidence of coinciding physiological changes

Question 3

What are the three types of delirium?

Answer 3

Hyperactive delirium
Hypoactive delirium
Mixed delirium

Question 4

What are the signs of hyperactive delirium?

Answer 4

Restlessness
Agitation
Inappropriate behaviour
Hallucinations

Question 5

What are the signs of hypoactive delirium?

Answer 5

Lack of interest
Lethargy
Reduced motor activity
Incoherent speech

Question 6

What are the signs of mixed delirium?

Answer 6

A mix of hyperactive and hypoactive signs

Question 7

What are the differentials of delirium?

Answer 7

Dementia
Pain
Stroke
Head trauma
Psychosis
Depression

Question 8

What are the risk factors for delirium?

Answer 8

Older age
Dementia or cognitive impairment
Decreased oral intake
Visual or hearing impairment
History of delirium
Polypharmacy
Physical frailty

Question 9

What are some common causes of delirium?

Answer 9

DELIRIUMS

D - drugs and alcohol
E - eyes, ears and emotional disturbance
L - low output state
I - Infection
R - retention
I - ictal (seizure activity)
U - Under hydration/ under nutrition
M - metabolic disorders
S - subdural haematoma, sleep deprivation

Question 10

What must be considered for a diagnosis of delirium?

Answer 10

Baseline cognitive and functional status to differentiate from dementia

Question 11

What investigations can be carried out to find a cause of delirium?

Answer 11

FBC - rule out anaemia or infection
U&Es
Urinalysis
CXR
Drug levels in patients on certain drugs
ECG
ABG
Blood culture

MMSE
Confusion assessment method - screening/diagnostic tool for delirium

Question 12

What drugs can cause delirium?

Answer 12

Benzodiazepines
Analgesics e.g opioids
Anti-cholinergics

Question 13

What is the primary treatment of delirium?

Answer 13

Treat the underlying cause

Question 14

What drugs can be given to manage the delirium itself?

Answer 14

IM haloperidol
(lorazepam in PD and lewy body dementia patients)

Question 15

What assessment tool can be used to diagnose delirium?

Answer 15

Short-CAM (confusion assessment method)

Question 16

What is the ICD-10 criteria for delirium?

Answer 16

Impairment of consciousness and attention
Global disturbance in cognition
Psychomotor disturbance
Disturbance of sleep wake cycle
Emotional disturbances