Delirium Flashcards
what is delirium?
- a geriatric emergency
- an acute decline in cognitive functioning
- usually in response to a noxious insult
- fluctuating syndrome of altered attention, awareness, and cognitive disturbances
what are some non-diagnostic terms describing delirium?
- senility
- dementia
- change in mental status
- acute confusional state
- sundowning
- disoriented
what are some adverse outcomes of delirium?
- higher rates of readmission
- higher rates of institutionalization
- higher mortality
what is the physiology of delirium?
- oxygen deprivation
- physiologic stress
- neurotransmitter hypothesis: reduced cholinergic function, increased dopamine
what are some PREDISPOSING factors for developing delirium?
- dementia
- previous episodes of delirium
- functional impairment
- sensory impairment
- major organ system/comorbidity
- depression
- hx TIA/CVA
- ETOH misuse
- older age (>75yo)
what are some PRECIPITATING factors for developing delirium?
- drugs
- polypharmacy
- use of physical restrains
- use of bladder catheter
- electrolyte imbalance
- infection
- surgery
what are the DSM V criteria for diagnosing delirium?
- disturbance in attention and awareness
- acute onset and fluctuating course
- change in cognition
- evidence of underlying medical condition, or from medication or drug withdrawal
what are the 3 clinical subtypes of delirium?
- hyperactive
- hypoactive
- mixed
how does hyperactive delirium present?
increased psychomotor activity, such as rapid speech, irritability, and restlessness
how does hypoactive delirium present?
- lethargy
- slowed speech
- decreased alertness
- apathy
how does mixed delirium present?
shift btwn hyper- and hypoactive states
what are some symptoms to look for when assessing delirium?
- attentional deficits
- disorganized thinking (altered thought content and thought process)
- disturbance of perception (hallucinations, illusions, delusions)
- disturbed sleep-wake cycle
- psychomotor activity (hyper- and hypo-)
what does the person with delirium experience?
- inability to interpret internal and external stimuli
- inability to formulate an effective response to negative stimuli
- inability to communicate needs
what are some differential diagnoses for delirium?
- dementia
- depression (41% misdiagnosed as depression)
- other psychiatric disorders
- CNS pathology
what are some ways to differentiate delirium from other causes of confusion?
- clinical history
- physical examination
- lab studies
- engaging IDT
what is the difference in onset between delirium and dementia?
- delirium: rapid onset
- dementia: insidious onset