Delirium

Question 1

What is delirium?

Answer 1

A syndrome involving disturbance of attention, orientation, and awareness resulting in an acute reversible state of confusion, usually affecting the elderly.

Delirium can present as either hyperactive or hypoactive and is characterized by cognitive and emotional disturbances.

Question 2

What are the two types of presentation of delirium?

Answer 2

• Hyperactive: restlessness, agitation, wandering
• Hypoactive: drowsy, quiet, withdrawn (more common)

Both presentations involve impairment of consciousness and attention.

Question 3

What is the duration of delirium?

Answer 3

Acute; hours to days, Chronic; weeks to months.

The duration can vary significantly depending on the underlying cause.

Question 4

What cognitive disturbances are associated with delirium?

Answer 4

• Delusions
• Hallucinations
• Confusion

These cognitive disturbances can manifest in various ways, affecting the patient’s perception of reality.

Question 5

What is psychomotor disturbance in delirium?

Answer 5

Flocculation/Carphology, which involves picking at imaginary objects or bedding.

This behavior is indicative of the confusion experienced by the patient.

Question 6

What are common emotional disturbances seen in delirium?

Answer 6

• Distress
• Apathy

Emotional response can vary widely among individuals experiencing delirium.

Question 7

What does the acronym PINCH ME stand for in the context of delirium causes?

Answer 7

• Pain (Head injury)
• Infections: UTIs, Encephalitis
• Nutrition (Alcohol, Hypoglycaemia)
• Constipation
• Hydration
• Medication (Polypharmacy esp sedatives)
• Environment (Being in hospital)

This mnemonic helps healthcare professionals remember the potential causes of delirium.

Question 8

What is the main difference between dementia and delirium?

Answer 8

Dementia is a chronic, progressive decline in cognitive function, while delirium is an acute, reversible state of confusion.

Understanding this difference is crucial for proper diagnosis and treatment.

Question 9

What initial tests are included in the confusion screen for delirium?

Answer 9

• Blood glucose
• Bloods (FBC, U&Es, LFTs, CRP, clotting)
• TSH
• Vitamin B12 and folate
• Bone profile
• CT/MRI (for pathology)
• CXR for suspected pneumonia

These tests help identify underlying causes of delirium.

Question 10

What screening tools are used for diagnosing delirium?

Answer 10

• Confusion Assessment Method (CAM)
• 4AT

The 4AT assesses alertness, orientation, and attention to aid in diagnosis.

Question 11

What are the key components of the 4AT assessment?

Answer 11

• Alertness
• Orientation (age, date of birth, place, current year)
• Attention (months of year backwards)

The 4AT is a quick tool for assessing cognitive function.

Question 12

What is the first step in the management of delirium?

Answer 12

Fix the triggers.

Identifying and addressing underlying causes is essential for effective treatment.

Question 13

What should be reviewed in medication management for delirium?

Answer 13

• Pain medication
• Opiates
• Anticholinergics
• Sedatives

These medications can contribute to delirium and may need adjustment.

Question 14

What is the stepwise approach to managing agitated patients with delirium?

Answer 14

• De-escalation (Talking down, Distraction)
• Oral Treatment (Antipsychotic or benzodiazepine)
• Rapid Tranquilisation (I/M antipsychotic or benzodiazepine)

This approach ensures patient safety while minimizing the use of medication.

Question 15

Fill in the blank: The management of delirium involves addressing the underlying causes, commonly remembered by the acronym _______.

Answer 15

PINCH ME

This acronym helps recall the various triggers of delirium.

Question 16

True or False: Delirium can present with sleep disturbances such as reduced arousal and reversed sleep-wake cycle.

Answer 16

True

Sleep disturbances are common in patients with delirium.