Delirium

Question 1

What is delirium? 3 points

Answer 1

Acute confusional state
Fluctuating
Inattention, impaired consciousness and disturbed cognition.

Question 2

What are the 3 types of delirium?

Answer 2

Hyperactive, hypoactive and mixed

Question 3

What characterises hyperactive delirium?

Answer 3

Inappropriate behaviour
Hallucinations
Agitation

Question 4

What characterises hypoactive delirium?

Answer 4

Lethargy
Reduced concentration
Reduced appetite

Question 5

What combination of factors can lead to delirium?

Answer 5

Predisposing factor (age, co-morbidity etc)
+
New precipitating factor (drugs, infection etc)

Question 6

How would you assess whether a patient has delirium?

Answer 6

short-CAM or DSM-IV

Question 7

How do you treat delirium?

Answer 7

Low stimulus environment
Treat cause
Optimise management of co-morbidities
Advice to carers about re-orientation, safe mobilisation and normalising the sleep-wake cycle

Question 8

Is pharmacological treatment appropriate?

Answer 8

Not usually, unless alcohol withdrawal in which case benzodiaz. = 1st line

Question 9

7 causes

Answer 9

Pain, infection, constipation, hydration status, hypoxia, medication, environmental

Question 10

6 risk factors

Answer 10

Age
Polypharmacy
Severe illness
Baseline cognitive impairment
Frailty
Sensory impairment

Question 11

Symptoms

Answer 11

Disordered thinking
Mood changes
Langauge impairment
Illusion/delusions/hallucinations
Reversal of sleep/wake cycle
Inattention
Unaware/disorientated
Memory defecits