Delirium Flashcards
Define Delirium
Global impairment of cognition;
Disturbances of attention, conscious level + psychomotor behaviour
Acute onset - Patients have worse prognosis for other acute illnesses because of Delirium
When are symptoms of Delirium worst?
At night
Fluctuate during the daytime
What are the signs for Delirium in its earliest stage?
Clouding of consciousness
Attention deficits
What are the main symptoms of Delirium?
Perceptual disturbance Visual hallucinations - tend to be transient Lack of concentration/awareness Withdrawal Disorientation Difficulty speaking Restlessness Disturbed sleep Emotional disturbances eg depression, anxiety
What are the 3 types of Delirium?
Hyperactive delirium - restlessness, agitation, rapid mood changes, hallucinations.
Hypoactive delirium - inactivity/reduced motor activity, drowsiness or seeming withdrawn.
Mixed delirium
What are some of the causes of Delirium?
Medication
Metabolic
Infection
CNS pathology
What are some of the drugs known to cause Delirium?
Antipsychotics Antidepressants Benzodiazepines Antiparkinsonian Anticholinergic Opiates Diuretics Recreational drug intoxication + withdrawal
What are some of the risk factors for Delirium?
Extremities of age esp > 65
Pre existing dementia/cognitive impairment
Illness severity
Current hip fracture
What is the Neuro-inflammatory hypothesis of Delirium?
Infection/Tissue damage/Pain/Blood loss/Anaesthetics cause inflammatory cascade producing inflammatory cytokines eg IL-1 + TNFα which then cause a response in other parts of the body
Why is Delirium an independent cause for Dementia progression?
Delirium causes neuronal death
How can you diagnose Delirium?
Assess clinical features eg fluctuating
Assess cognitive function eg AMT, MMSE
Identify causative factors
What are the supportive measures for managing Delirium?
Treat underlying condition Hydration/nutrition Attention to environment Control distressing physical symptoms Hearing/visual aids made available Avoid unnecessary procedures Promote healthy sleeping patterns
What drugs can be given to manage Delirium?
Start with low dose eg 0.5-1mg BD Haloperidol/Olanzipine and use at the lowest effective dose for the minimal amount of time
Do NOT use long acting drugs eg Diazepam, drugs with multiple side effects eg Chlorpromazine
What are some of the non pharmacological treatments for Delirium?
Good lighting Quiet/calm wards so less distractions Same staff so familiar faces Prevent transfers if possible Keep good routines
What patients with Delirium can be difficult to treat?
Hyperactive type patients - May be resistant and put themselves/others at risk. Can give life saving treatments to acutely ill patients without capacity
