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Year 4 Psychiatry > Delirium > Flashcards

Delirium Flashcards

1
Q

What is delirium?

A

It is an acute confusional state, and is common in hospitalised patients (up to 45% of over-65s in hospital)

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2
Q

How is delirium defined according to ICD-10?

A

An aetiologically non-specific syndrome characterised by concurrent disturbances of consciousness and attention, perception, thinking, memory, psychomotor behaviour,, emotion and sleep-wake cycle, that is transient and of fluctuating intensity

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3
Q

Which drugs can commonly cause delirium? (12)

A
  1. Alcohol
  2. Opiates
  3. Sedatives
  4. Anticholinergics
  5. Diuretics
  6. Steroids
  7. Digoxin
  8. Anticonvulsants
  9. Lithium
  10. TCAs
  11. MAOIs
  12. L-dopa
    …and polypharmacy
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4
Q

Which metabolic disorders can cause delirium? (6)

A
  1. Renal failure
  2. Hepatic failure
  3. Respiratory failure
  4. Cardiac failure
  5. Electrolyte imbalances
  6. Dehydration
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5
Q

What are the infective causes of delirium? (5 - tons more)

A
  1. UTI
  2. Pneumonia
  3. Sepsis
  4. Endocarditis
  5. HIV
    etc.
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6
Q

What are the neurological causes of delirium? (5)

A
  1. Stroke
  2. SAH
  3. Head injury
  4. Space-occupying lesion
  5. Epilepsy
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7
Q

What are the others causes of delirium that aren’t necessarily medically related? (5)

A
  1. Stress
  2. Sleep deprivation
  3. Change in environment
  4. Urinary retention
  5. Constipation
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8
Q

What is the typical pattern of delirium in a 24 hour period?

A

In many cases the course is diurnally fluctuating, with the patient relatively settled during the daytime and most agitated in the evening (sundowning), and in cases of hypoactive delirium, they may not be agitated at all

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9
Q

In terms of consciousness, how does this differ between dementia and delirium?

A

In delirium it is altered, whereas in dementia it is usually clear

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10
Q

What are the first-line investigations for someone with suspected delirium? (7)

A
  1. Psychiatric history
  2. Mental state examination
  3. Cognitive assessment
  4. FBCs, U&Es (LFTs, TFTs, glucose, thiamine level, blood drug screen)
  5. Urinary dipstick, MSU (sputum samples, blood cultures, LP)
  6. CXR (AXR, CT head, MRI head)
  7. ECG (EEG)
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11
Q

What simple measures can be taken to prevent onset of delirium? (6)

A
  1. Ensuring sensory aids e.g. hearing aids/glasses are in place
  2. Encouraging fluids/nutritional intake and correcting electrolyte imbalances
  3. Rationalising drug charts
  4. Encouraging mobilisation
  5. Encouraging family members to spend time at the bedside
  6. Clocks, calendars and familiar objects from home can be brought in
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12
Q

What is the drug of choice to manage the symptoms of delirium?

A

Haloperidol

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13
Q

If the delirium is caused by alcohol or benzodiazepines, what is the drug of choice to help with agitation or psychosis?

A

A benzodiazepine

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14
Q

What are the complications of delirium? (7)

A
  1. Prolonged hospital stay (and thus increased risk of infections)
  2. Accelerated cognitive decline
  3. Aspiration pneumonia
  4. Fluid and electrolyte imbalance
  5. Malnutrition
  6. Falls
  7. Injuries
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15
Q

What are the three subtypes of delirium?

A
  1. Hyperactive
  2. Hypoactive
  3. Mixed
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16
Q

How does hyperactive delirium tend to present? (4)

A
  1. Inappropriate behaviour
  2. Hallucinations
  3. Agitation
  4. Restlessness, wandering
17
Q

How does hypoactive delirium tend to present? (4)

A
  1. Lethargy
  2. Reduced concentration
  3. Reduced appetite
  4. Withdrawn and quiet
18
Q

Although the pathophysiology of delirium is not fully understood, what are the mechanisms thought to be involved? (3)

A
  1. Cholinergic deficiency
  2. Dopaminergic excess
  3. Inflammation
19
Q

Although the precipitation factors/causes of delirium have been addressed, what are the predisposing risk factors for delirium? (9)

A
  1. Older age
  2. Cognitive impairment (e.g. dementia)
  3. Frailty
  4. Significant injuries e.g. hip fracture
  5. History of alcohol excess
  6. Sensory impairment
  7. Poor nutrition
  8. Lack of stimulation
  9. Terminal phase of illness
20
Q

Name two warning signs for delirium?

A
  1. Falling

2. Loss of appetite

21
Q

What is the confusion assessment method (CAM) criteria for diagnosing delirium? (4)

A
  1. Confusion that has developed suddenly and fluctuates
  2. Inattention - ask if the person is easily distracted and has difficulty in focussing attention
  3. Disorganised thinking (unclear flow of ideas, change subject unpredictably)
  4. Altered level of consciousness
22
Q

What is the DSM-IV criteria for delirium? (4)

A
  1. Confusion that has developed over a short period of time and fluctuates
  2. Disturbance of consciousness
  3. Change in cognition
  4. Evidence from history, examination and investigations which is consistent with delirium and cannot be attributed to another diagnosis
23
Q

According to NICE CKS, what investigations need to be carried out in someone with suspected delirium and briefly why? (13)

A
  1. Urinalysis (infection/hyperglycaemia)
  2. Sputum culture (chest infection)
  3. FBC (infection/anaemia)
  4. Folate/B12 (vitamin deficiency)
  5. U&Es (AKI/electrolyte disturbance)
  6. HbA1c (hyperglycaemia)
  7. Calcium
  8. LFTs (hepatic failure/rule out hepatic encephalopathy)
  9. Inflammatory markers (CRP)
  10. Drug levels (drug toxicity e.g. lithium)
  11. TFTs (hyper/hypothyroidism)
  12. CXR (e.g. pneumonia, heart failure)
  13. ECG (cardiac conditions e.g. arrhythmias)
24
Q

What are the differentials for delirium? (6)

A
  1. Depression
  2. Dementia
  3. Mental illness
  4. Anxiety
  5. Thyroid disease
  6. Charles Bonnet syndrome

Year 4 Psychiatry (14 decks)

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