Delirium Flashcards

1
Q

What are 4 aspects of the DSM-IV diagnostic criteria of delirium?

A

Disturbance of consciousness; change in cognition not accounted for by dementia; hours/days to develop and fluctuate during day; disturbance caused by consequences of a medical condition.

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2
Q

What are some common symptoms of delirium?

A

Fluctuating inattention, disorganised thinking, impaired cognition, altered consciousness, altered sleep-wake cycle, emotional disturbace.

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3
Q

What are 4 psychomotor variants of delirium? How common is each? Which form is under/misdiagnosed?

A

25% hyperactive, 25% hypoactive (under/misdiagnosed), 35% mixed with flux and lucid intervals, 15% normal.

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4
Q

List 6 predisposing factors of delirium.

A

Age, impaired cognition, history of delirium, depression, visual/hearing impairment, dehydration, malnutrition, drugs, chronic disease.

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5
Q

List 4 precipitating factors of delirium.

A

Drugs, neurological disease, intercurrent illness, surgery, sleep deprivation, poor environmental factors (eg. catheter, poor lighting, immobility)

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6
Q

What is the relative prevalence of delirium in patients in a medical ward, in ICU and palliative care? Why is it important to recognise?

A

Medical: 5-80%; ICU: 7-83%; pall care: 45%.

Increases mortality, hospital stay, complications (falls/incontinence/pressure sores).

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7
Q

What are the 4 components of the Confusion Assessment Method (CAM) and what other test must be done to validate the results? What are the results for delirium?

A

1 Acute onset + fluctuating course; 2 inattention; 3 disorganised thinking; 4 altered level of consciousness. Need cognitive assessment too. Delirium: (1+2) + 3 or 4

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8
Q

What are 2 key distinguishing features between dementia and delirium? Which form of dementia is most easily confused with delirium?

A

Timing: dementia develops over months/years (vs hours/days) and won’t fluctuate over hours.
Impaired attention is a key feature of delirium, mostly intact in dementia.
Dementia with Lewy bodies - visual hallucinations and fluctuations possible.

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9
Q

What are recommended 1st line investigations when suspecting delirium? What other tests may be considered?

A

FBE, CRP & ESR, Urea & electrolytes, glucose, LFTs, CMP.
Consider: MSU, CXR, blood cultures. CT brain, TFTs, drug levels.

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10
Q

What are 3 supportive measures in managing delirium?

A

Protect airway, maintain hydration and nutrition, position and mobilise.

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11
Q

What is involved in the non-pharmacological management of delirium? What are 2 things to avoid?

A

Create a calm & comfortable environment & involve relatives if possible. Orientate with calendars/clocks. Minimise staff changes. Avoid sleep deprivation, exercise in day. Avoid restraint and immobilising devices.

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12
Q

When is pharmacotherapy indicated in managing delirium?

A

If safety of patient or others threatened; delirium preventing essential therapy/care for other condition.

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13
Q

What drugs are most used in managing delirium? What are they used for?

A

Haloperidol, respirdone. Only for agitation/hallucination. Not hypo symptoms. Not with Parksinons or lewy body dementia.
Benzos only if anxiety or withdrawal and best avoided.

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14
Q

How long does it take for delirium to resolve if treated? What are some possible complications? What are 3 things to consider before/at discharge?

A

Usually resolve in days to week. May suggest dementia, cognition may be impaired. Risk of decline. Educate family/carers; assess meds; assess driving ability.

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