Delirium Flashcards
How common is it?
The prevalence in the general population is about 0.4%.
Who does it affect?
The prevalence of delirium among people aged 65 years and over living in long term care is 10-40%. It is also thought to affect up to 50% of older people in hospital and occur in 30% of older people in emergency departments. Complicates 17-61% of major surgery.
What causes it?
Bloody anything
Infection such as urinary tract infection, infected pressure sore or pneumonia.
Metabolic disturbance such as hypoglycaemia, hyperglycaemia, or electrolyte abnormalities (including that due to dehydration).
Cardiovascular disorders such as MI or heart failure. Respiratory disorders such as PE or exacerbation of COPD.
Neurological disorders such as stroke, encephalitis, or subdural haematoma.
Endocrine disorders such as thyroid dysfunction or Cushing’s syndrome.
Urinary retention, constipation, hepatic failure, malnutrition.
Severe pain, alcohol intoxication or withdrawal.
Medication (including opioids, benzodiazepines and others).
What risk factors are there?
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- Cognitive impairment (e.g. dementia).
Frailty/multiple comorbidities (such as stroke or heart failure).
Significant injuries such as hip fracture.
Functional impairment (immobility).
Iatrogenic events (bladder catheterisation, polypharmacy or surgery).
History of or current alcohol excess.
Sensory impairment.
Poor nutrition.
Lack of stimulation.
Terminal phase of illness.
How does it present?
Behaviour changes develop acutely (hours to days)
Lucid intervals usually occur during the day with worst disturbances at night.
Altered cognitive function:
- disorientated
- memory and language impairment
- worsened concentration
- slow responses and confusion.
Inattention. Disorganised thinking. Altered perception: may experience paranoid delusions, misperceptions or hallucinations (30%) which can be distressing.
Falling and loss of appetite are often warning signs for delirium.
Hyperactive delirium:
- Increased sensitivity to their surroundings, agitation + restlessness
Hypoactive delirium (more common):
- Clouding of consciousness +reduced awareness
Mixed:
- Have signs and symptoms from both
Investigations
Collateral history and anything you think will illuminate the underlying cause.
Treatment
Always treat the underlying condition. But low dose haloperidol can be used short term (<7/7). Or low dose lorazepam. But drug treatment does not seem very effective.
Conditions that would present similarly
Depression
Dementia
Mental illness (schizophrenia)
Anxiety
Thyroid disease
Non-convulsive epilepsy or temporal lobe epilepsy.
Charles bonnet syndrome: visual hallucinations may occur in people with severe visual impairment and can range from simple patterns of straight lines to detailed pictures of people or buildings.
