delirium

Question 1

what is delirium

Answer 1

acute or subacute brain failure- impairment of attention with abnormalities in perception and mood

Question 2

features

Answer 2

confusion worse at night. sleep reversal. thought and speech incoherent in the acute phase, memory impaired, misperceptions. visual hallucinations/illusions/persecutory delusions

Question 3

predisposing factors

Answer 3

extremesof age, damaged brain (dementia, previous head injury, alcoholic brain damage, previous stroke); unfamiliar environment, sleep deprivation, visual/ hearing impairment; sensory extremes, immobilisation

Question 4

common causes- systemic

Answer 4

any infection especially with high fever

Question 5

causes- metabolic

Answer 5

electrolyte imbalance, dehydration, CKD, hypoxia, hepatic failure

Question 6

causes- vitamin

Answer 6

thiamine- Wernicke Korsakoff; b12; nicotinic acid

Question 7

causes- endo

Answer 7

cushings, hypothyroid

Question 8

causes- drugs

Answer 8

dopamine agonists, anti convulsants, anxiolytics, antimuscarinics, digoxin, TCAs

Question 9

diagnostic criteria

Answer 9

disturbance consciousness, change in cognition, disturbance over short period, fluctuation over the course of a dy

Question 10

what drugs should you avoid giving

Answer 10

psychoactive drugs, benzos as can prolong confusion

Question 11

what can you use to treat if severe delirium

Answer 11

haloperidol 1.5mg in elderly up to 30mg per day. olanzapine can be effective especially if given at night for insomnia