Delirium

Question 1

What is delirium?

Answer 1

An acute, fluctuating syndrome of disturbed consciousness, attention, cognition + perception

Question 2

What is delirium recognised by?

Answer 2

a change in consciousness, either hypo or hyperalert, + inattention

Question 3

Causes of delirium

Answer 3

THINK DELIRIUM
- Trauma (pain)
- Hypoxia
- Increasing age/frailty
- Neck of femur fracture
- smoKing or alcohol withdrawal
.
- Drugs
- Epilepsy / Electrolyte imbalance
- Liver failure / Low oxygen
- Infection e.g. UTI
- Retention (constipation)
- Intracranial e.g. stroke
- Uraemia
- Metabolism e.g. hypoxia

Question 4

What patients in hospital are at risk of delirium?

Answer 4

• frail patients
• sensory impairment
• cognitive impairment
• having surgery
• hip fractures
• severe infection

Question 5

What test is used to screen for delirium?

Answer 5

4AT test
(+AMT-4 test)

Question 6

What makes the 4AT test?

Answer 6

• alertness
• AMT4: age, DOB, location, current year
• attention: list months in reverse from december
• acute change or fluctuating course

Question 7

Difference in presentation of delirium and dementia

Answer 7

Delirium - sudden onset
Dementia - progressive

Question 8

Types of delirium + their presentation

Answer 8

• Hyperactive: agitated, aggressive + delusions
  Or
• Hypoactive: drowsy + withdrawn

Question 9

Treatment of delirium

Answer 9

• treat underlying cause
• treat/minimise precipitating factors
• encourage normal day/night cycle
• allow wandering if safe
• involve loved ones
• distraction techniques
• haloperidol as last resort

Question 10

What medication is used in delirium if non-pharmacological treatments have failed?

Answer 10

Haloperidol

Question 11

Mechanism of action of haloperidol

Answer 11

typical antipsychotic drug
- blocks dopamine D2 receptor

Question 12

Side effects of haloperidol

Answer 12

• arrhythmias
• QT interval prolonging
• rash
• constipation/urinary retention
• extrapyramidal symptoms
• anticholinergic effects

Question 13

Contraindications of haloperidol

Answer 13

• DEMENTIA
• history of ventricular arrhythmias
• history of torsade de pointes
• prolonged QT syndrome
• recent MI

Question 14

What are extrapyramidal symptoms?

Answer 14

• hyperprolactinaemia side effects
• dystonia
• parkinsonianism

Question 15

What are hyperprolactinaemia side effects?

Answer 15

• galactorrhoea
• amenorrhoea
• decreased fertility
• ED
• osteopenia/osteoporosis
• reduced libido

Question 16

What are anticholinergic side effects?

Answer 16

• dry mouth
• confusion
• flushed skin
• hyperthermia
• tachycardia
• dilated pupils
• urinary retention
• absent bowel sounds