Delirium

Question 1

Define delirium:

• what is it?
• onset?
• cause?

Answer 1

-disturbance in attention
change in cognition (e.g. memory deficit, disorientation, language disturbance, perceptual disturbance)

• acute, fluctuates throughout day
• direct physiologic consequence of a general medical condition/ intoxication substance/ medication use/ multiple causes

Question 2

Delirium, describe:
onset
course
duration
activity
alertness
attention
mood
thinking
perception

Answer 2

sudden
short, fluctuating
hours to less than a month
Agitation in hyperactive , restless OR sleepy, slow in hypoactive

Question 3

Pathophysiology
levels of ACh become what?
give examples of direct toxic insults to the brain (4)
-what other factors contribute?

Answer 3

• deranged
• drugs, hypoxia, low Na, low glucose
• cortisol, prostaglandins, cytokine release, serum cholinesterase activity

Question 4

predisposing factors to delirium? (10)

Answer 4

advanced age
pre-existing dementia
co-morbidity
post-op
terminal illness
sensory impairment 
polypharmacy
depression
alcohol dependency
malnutrition

Question 5

What are the 4 hallmarks of delirium?

Answer 5

acute and fluctuating
inattention
Altered level of consciousness
disorganised thinking

Question 6

what are the subtypes of delirium? (2)

Answer 6

Hyperactive: agitated aggressive, wandering

hypoactive: withdrawn, apathetic, sleepy, coma

Question 7

Management? (4)

Answer 7

identify and reverse underlying cause
environmental and supportive factors
symptom control
stop nephrotoxic drugs and look for renal disease

Question 8

what are the environmental and general measures?

Answer 8

Approach patient calmly and gently from front,
sleep chart,
allow mobilisation as much as possible in safe area,
ensure glasses and hearing aids working
adequate diet
orientate with clocks and calendar
reduce noise

Question 9

Medications used?

Answer 9

Haloperidol
(start low dose 0.25-0.5mg)
Quetiapine
(25mg orally in Parkinsons/lewy body)
Benzodiazepines
(NOT lorazepam)