Delirium Flashcards
onset of disturbance
over a short period of hours to a few days; tends to fluctuate in severity throughout the course of the day
delirium
disturbance of attention and awareness
an additional disturbance of cognition
signs/symptoms
altered level of consciousness perceptual disturbances delusions, often paranoid disturbed sleep-wake cycle increased or decreased activity level emotional disturbances cognitive disturbances
two types of delerium
hyperactive delerium
hypoactive delierum [confused for depression]
delerium is frequent in
post-operative situations
risk factors of delirium
advanced age pre-existing dementia medical comorbidity h/o brain injury h/o alcohol abuse male sex sensory impairment malnourishment, dehydration
consequences of delirium
increased length and cost of hospitalization (nosocomial complications)
decreased independent living status and increased instiutionalization
increased risk of death up to 2 years following
delerium etiology
brain dysfunction related to underlying medical condition, NOT a primary psychiatric illness
NT thought to be involved in pathphys of delerium
dopamine and acetylcholine
neurological signs
none
EEG
diffuse slowing
general dysfunction og
subcortical and cortical structures (particularlly in nondom hemisphere)
effective in treating symptoms
anti-dopaminergic agents
(haloperidol)
mixed results for cholinesterase inhibitors
causes of delerium
I WATCH DEATH
Infections (pneumonia, UTI) W withdrawal Acute metabolic Trauma Ccns pathology Hypoxia Deficiencies (vit b12, thiamine( Endocrinopathies (thyroid, pT, glucose) Acute vascular (CVA, MI, PE, CHF) Toxins/drugs (prescribed or recreational) Hheavy metals
two possible mechanisms for delirium
excess dopaminergic activity
reduced cholinergic activity
drugs associated with delirium
opiates
anticholinergic drugs
corticosteroids
benzos
key to this diagnosis vs other things (mania, schizo, dementia, depression)
these other disorders are not generally associated with altered sensorium or fluctuating attention
Confusion Assessment
Acute onset and fluctuating course
inattention
disorganzied thinking
altered level of consciousness
need 1&2 plus EITHER 3 or 4
behavioral treatment of delirium
orientating stimuli (clocks, calendars) support regular sleep-wake cycle eyeglasses and hearing aids when indicated mobilize patient as soon as possible ensure adequate nutrition educate and support family restraints ONLY WHEN NECESSARY
typical antipsychotic
haloperidol
atypical antispyschotics
growing evidence to support use
olanzapine and ziprasidone
nonbenzo anxiolytics
trazodone
gabapentin
benzos
avoid unless delirum is withdrawl, antipsychotics contraindicated
potential for paradoxical effect
lorazapam best!
