Delirium Flashcards
1
Q
Define delirium
A
Acute, fluctuating change in mental status - inattention, disorganised thinking, altered level of consciousness
2
Q
Delirium epidemiology
A
- 10% >70 yo Aussies - delirium at time of hospital admission
- > 30% patients with delirium - post-hip and cardiac surgery, ICU stay
3
Q
Clinical presentation of delirium
A
- Battle to pay attention/stay focused
- Unable to think clearly
- May have hallucinations or paranoia
- Problem with memory
- Rambling/incoherent speech
- Poor perception
4
Q
Medical aetiologies of delirium - examples
A
- Severe illness
- Constipation
- Dehydration
- Infection
- Pain
- Drug effect/withdrawal
5
Q
Precipitating insults for delirium
A
- Infection
- Metabolic derangement
- Environmental factors
- Sleep deprevation
- Surgery
- A primary illness
6
Q
Risk factors for delirium
A
- Old age
- History of delirium
- Functional impairment
- Polypharmacy
- Surgery
- Dementia/cognitive impairment
- Vision/hearing impairment
- Decreased oral intake
- Co-existing medical conditions
- Physical fragility
7
Q
Delirium pathophysiology
A
- Disruption in higher cortical functioning in many areas of the brain - includes prefrontal cortex, subcortical structures etc
- EEG - shows diffuse slowing of cortical activity
- Neurotransmitters - cytokines, IL1/2, TNF alpha
- Inflammation
- Chronic stress - hypercortisolism
- Cholinergic deficiency
- Dopaminergic excess
8
Q
Delirium differential diagnosis
A
- Dementia
- Pain
- Stroke/TIA/CVA
- MI
9
Q
Delirium and mortality
A
- Mortality 2x as much with delirium in hospital vs no delirium
- 14% mortality within 1 month of diagnosis
- Delirium in critically ill - increased LoS and increased mortality
10
Q
Delirium is associated with an increased risk of……
A
- Functional and cognitive decline
- Poor rehab potential
- Institutionalise
- Re-hospitalisation
11
Q
Delirium - tools for diagnosis
A
- PRIMARILY CLINICAL
- Previous cognitive state history
- Delirium screening tools
- Medication use
- Comorbidities
- Pain levels
- Alcohol and drug use
12
Q
Delirium screening tools
A
- CAM = confusion assessment method
- CAM-ICU
- ICDSC = intensive care delirium screening checklist
- DTS = delirium triage screen
13
Q
DSM-5 classification - delirium
A
- Disturbance in attention = decreased ability to focus, sustain or shift attention
- Change in cognition/perceptual disturbance
- Disturbance develops over a short period of time - hours to days - acute change from baseline - tends to flucutate throughout day
- Evidence = history, exam, lab findings
14
Q
Clinical subtypes of delirium
A
- Hypoactive (lethargy, reduced motor activity, incoherent speech, lack of interest)
- Hyperactive (heightened arousal, restlessness, agitation, hallucinations, inappropriate behaviour
- Mixed
15
Q
Treating delirium
A
- Supportive care
- Antipsychotics
- Benzodiazepines
