Delirium Flashcards
Delirium
Clinical syndrome involving abnormalities of thought, perception and levels of awareness. Typically of acute onset, and intermittent
Features of delirium (DELIRIUM)
Disordered thinking Euphoric, fearful, angry or depressed Language-impaired Illusions/hallucinations/delusions Reversal of sleep/wake cycle Inattention Unaware (disorientated) Memory deficits
Tools used to diagnose delirium
Confusion Assessment Method
4AT
Components of the CAM (4)
Acute change in mental status, fluctuating AND Inattention AND Disorganised speech OR Altered consciousness level
Which particular kind of delirium is often under-diagnosed?
Hypo-active
How can inattention be tested for?
Digit span test (less than seven in abnormal)
Aimless, involuntary picking at bedclothes often seen in delirium
Floccillation
Contraindications to haloperidol (2)
Lewy body dementia
Parkinsons
Commonly missed causes (3)
Urinary retention
Constipation
Pain
Complications of delirium in hospital setting (3)
Prolonged stay and increased complications such as:
Nosocomial infections
Falls
What does delirium often represent?
An atypical presentation of an acute medical illness
Predisposing factors towards delirium (5)
Old age Pre-existing dementia Sensory impairment Terminal illness Post-operative
Components of the 4AT
Alertness
Age, DOB, place, current year
Attention (recite months backwards)
Acute change or fluctuating
Sedatives used in delirium (3)
Haloperidol (oral if possible- low dose)
Qutiepine (for Parkinson’s, Lewy Body dementia)
Lorazepam
How should sedation be given in delirium? (2)
As a last resort when other measures have failed; should be clearly documented in the notes why sedation was required
