Delirium Flashcards
What are the 2 features which must be present to be diagnosed with delirium?
Acute change or fluctuating course of mental status
Inattention
What are the 2 features of which 1 must be present to be diagnosed with delirium?
Disorganised thoughts
Altered level of consciousness
What are the two main types of delirium?
Which of these is the most commonly recognised type?
What are these features known as?
Hyperactive and hypoactive
Hyperactive
Psychomotor disturbance
How does delirium typically develop?
What is its course like?
At what time in the day is it often worse?
How long does it usually last?
Very acutely (hours - days)
Fluctuating
Often worse at night
Average is 1-4 weeks, though can vary
Patients with delirium often have disturbance of cognition. What are some examples of this?
Disorientation (most commonly to time, but can also be people and place)
Visual hallucinations (which can lead to secondary delusions)
Patients with delirium often have a disturbance of the sleep-wake cycle. Give some examples of problems this can cause?
Reversed sleep cycle
Nocturnal worsening of symptoms
Disturbing dreams and nightmares
What are some potential causes of delirium?
Infections
Metabollic problems
Medications
Drugs/alcohol
What determines what investigations would be done for suspected delirium?
What are some that could be used?
What you thought the causative factor could be
Formal cognitive tests
Bloods and urinalysis
Sepsis screen
ECG
MRI/CT head
If patients with delirium have no capacity, they should be treated according to what act?
AWIA section 47
What are the reasons why patients with delirium should always be followed up?
They may remember the event and find it distressing
Increased risk of dementia, and delirium again in the future
What are some non-pharmacological ways to manage a patient with delirium?
Allow mobilisation
Ensure glasses and hearing aids are used if necessary
Try to reduce background noise
Reassess and reorientate frequently
When should medical management be used for delirium?
What is the first line medication used?
What dose should be started with and how should it be given?
What is the maximum dose of this you can give?
Who can this medication not be given to?
Only if the patient is a risk to themselves or others
Haloperidol
Start with 0.25-0.5mg PO (if unsuccessful, try IM)
5mg in 24 hours
Patients with Parkinson’s or Lewy body dementia
What medical management should be used for delirium if the patient has Parkinson’s or Lewy body dementia?
What dose should be given?
Quetiapine
25mg orally
What medical management should be used for delirium as a result of alcohol or drugs?
What dose should be used?
What is the maximum that can be used?
What is significant about the use of this medication in delirium?
Lorazepam
0.5-2mg
Two doses in 24 hours
It can actually make it worse
What is it known as when a person gets delirium as a result of drug/alcohol withdrawal?
What medications can be used to treat withdrawal?
Delirium tremens
Diazepam or chlordiazepoxide
