Delirium

Question 1

What is it?

Answer 1

impaired consciousness with intrusive abnormalities of perception and affect

Question 2

What are the diagnostic criteria? (5 features)

• expand on each of these
• general?

Answer 2

impairment of consciousness
(clouding, drowsiness, stupor, coma)

Disturbance of cognition
(disorientated for time but sometimes place and person also, impaired memory, attention, thinking, perceptual disturbance, hallucinations and illusions)

Psychomotor disturbance 
(hyperalert/hyperactive: agitation, disorientation, hallucinations, delusions, aggression) OR (hypoalert/hypocative: confusion, sedation, depression misdiagnosis) OR (Mixed: fluctuating)

Disturbance of sleep wake cycle
(insomnia, sleep loss, reversal of sleep cycle, nocturnal worsening od symptoms, dreams & nightmares)

Emotional disturbance
(depression, anxiety, fear, irritability, euphoria, apathy, perplexity, aggression)

-rapid onset,
transient and fluctuating course
can last days-months

Question 3

Give the causes of delirium in general terms and then expand on each (8: 9,4,9, -, -, 4, -, 6)

Answer 3

Drugs
(Alcohol/illicit drugs, anticholinergics, anticonvulsants, anti-parkinson, steroids, cimetidine, opiates, sedatives)

Withdrawal
(alcohol, benzos, barbiturates, illicit)

Metabolic
(Hypoxia, hypoglycaemia, compromised liver/kidney, fluid/electrolyte imbalance, hypo/hyperthyroid, hypopituitarism, Hypo/hyperparathyroidism, Porphyria, carcinoid syndrome)

Infections

Head trauma

Epilepsy
(Aura, octal, interictal, postictal)

Neoplastic diseases

Vascular disorders

(TIA, thrombosis, embolism, migraine, MI, cardiac failure)

MIGHT NOT BE IDENTIFIABLE CAUSE: does not exclude Dx

Question 4

risk factors? (10)

Answer 4

age
cognitive deficit
existing sensory deficit
prev episode
preoperative
sensory extremes
immobility
social isolation
new environment
stress

Question 5

Investigations?

Answer 5

Hx and full examination 
MMSE/4AT
urine analysis
FBC, U&E, LFTs, TFTs
Blood glucose
CRP
B12 and folate
CXR
CT brain 
EEG

Question 6

Management

-what are the 4 main features of management, expand?

Answer 6

identify and treat cause
(might need to sedate, might need corroborative hx)

Manage environment and provide support
(orientate: clear communication, clock, calendar,
Correct sensory impairment: glasses, hearing aids
Bright side room with unnecessary noise reduced, unsafe objects removed
ensure basic needs met)

Prescribe
(antipsychotics standard, haloperidol 1-10mg
sedation can worsen
withdrawal- Diazepam or chlordiazepoxide)

Review
(might improve quickly but also worsen quickly
follow up)