Delirium

Question 1

Define delirium

Answer 1

Disturbance in attention
Change in cognition
Developing over a short period
Fluctuating course

Question 2

Compare the onset of delirium with dementia

Answer 2

Dementia: chronic, slow
Delirium: acute, sudden

Question 3

Compare the course of delirium with dementia

Answer 3

Dementia: progressive, irreversible
Delirium: fluctuating, reversible

Question 4

List some symptoms of delirium

Answer 4

Agitation, restless (hyperactive)
Slow, sleepy (hypoactive)
Fluctuating emotions
Impaired attention

Question 5

List predisposing factors for getting delirium

Answer 5

Old age
Sensory impairment
Polypharmacy
Dementia, depression
Alcohol dependency
Malnutrition
Post-op (typically hip fracture)

Question 6

Hypoactive delirium has twice the mortality of hyperactive delirium. True/False?

Answer 6

True

Question 7

Describe the 4AT tool for diagnosing delirium

Answer 7

Alertness (name and address)
AMT4 (age, dob, place, year)
Attention (months of yr backwards)
Fluctuating course

Score of 4 or more = delirium

Question 8

State the 4 hallmark features of delirium, described by the confusion assessment method (CAM)
Give some ways of testing these

Answer 8

Acute onset and fluctuating course (collateral Hx)
Inattention (months of yr backwards)
Disorganised thinking (how did you get to hospital?)
Altered consciousness (alert, vigilant, lethargic, stupor, coma)

Question 9

How is delirium mainly treated?

Answer 9

Support (oreintation, sleep, environment), advice, reassurance, education
Identify and treat causes
Symptom control
Follow up and review

Question 10

Which medication may be used for delirium?

Answer 10

Haliperidol low-dose oral
Quetiapine if Parkinson’s
Benzodiazepine if alcohol withdrawal

Question 11

List precipitating factors for getting delirium

Answer 11

PINCH ME

PAIN
ILLNESS: urinary retention
INFECTION: UTI, lungs, stomach
NEUROLOGICAL: withdrawal, alcohol
CONSTIPATION
CATHETER
CARDIOEMBOLIC
HYDRATION
HYPO: thyroid, natraemia, kalaemaia, thermia, glycaemia, xia
MEDICATION: new meds/ change in meds
ENVIRONMENTAL: hospital, surgery

Question 12

What must be considered when discussing treatment with a delirious patient?

Answer 12

Capacity

Question 13

What medication must be stopped in delirium?

Answer 13

Nephrotic drugs (check for intrinsic renal disease)
Strong opiates
Sedatives

Question 14

What must be assessed and optimised when managing a delirious patient?

Answer 14

Hydration

BP/ perfusion

Question 15

Why must a delirious patient be followed up?

Answer 15

Address flashbacks/ recollection
Risk factor for dementia
Risk of further episodes of delirium

Question 16

What phrases can be used to reassure family/ carers?

Answer 16

‘Acute state of confusion’
‘I understand they are not themselves, this must be upsetting’
‘Usually due to underlying cause - infection’
‘Distressing symptoms usually resolve in a week, sometimes longer’