Delirium

Question 1

What is delirium?

Answer 1

Acute fluctuating change in mental status

Question 2

How does delirium present?

Answer 2

Acute onset
Fluctuating course
Inattention, disorganised thinking and altered levels of consciousness

Question 3

What are the subtypes of delirium?

Answer 3

hyperactive - agitated, aggressive, wandering

hypoactive - withdrawn, apathetic, sleepy

Question 4

What type of delirium is easy missed?

Answer 4

Hypoactive

Question 5

What is the DSM-5 criteria?

Answer 5

Patient must show all 4 of: 
disturbance in attention 
change in cognition 
short period of time and fluctuates 
evidence from investigations, history and exam that disturbance is directly caused by medical condition, substance intoxication or withdrawal

Question 6

What are some causes of delirium?

Answer 6

infection e.g. pneumonia, UTI 
encephalitis/meningitis 
drugs (opiates, anticonvulsants)
alcohol withdrawal
liver failure 
hypoxia 
stroke/MI
epilepsy

Question 7

How is delirium diagnosed?

Answer 7

4AT scoring

Question 8

What do the 4 A’s in 4AT stand for?

Answer 8

alertness
AMT4 (abbreviated mental test)
attention
acute change or fluctuating course

Question 9

How is delirium treated?

Answer 9

ID and reverse underlying causes
Environmental and supportive factors
Review and follow up
Medication e.g. haloperidol, quetiapine, benzos ONLY IF PT IS RISK TO SELF OR OTHERS