Delirium Flashcards
What is delirium
Acute confusional state
Name some causes
Drugs
Dehydration
Constipation
Withdrawal
Deficiencies
Pain
Electrolyte imbalance
Environmental changes
Hypoxia
Lack of sleep
Long stay
Infection
Infarction
Iatrogenic event
Restricted movement
Organ failure
Injury
Impaired sensory input
Intoxication
Metabolic
What does PInCHME stand for and what is it?
Broad causes of delirium
Pain
Infection
Constipation
Hydration
Medication
Environment
What are 4 risk factors for delirium
> 65yo
Dementia or prev cog impairment
Hip fracture
Acute illness
Clinical features of delirium
globally impaired cognition, perception and consciousness which develops over hours/days
Memory deficit
Disordered/disorientated thinking
Reversal of sleep/wake cycle
Sometimes tactile/visual hallucinations
Delirium is split into which categories
Hypo and hyperactive (or mixed)
How is hyperactive delirium characterised?
Restless, agitated, aggressive, labile mood
How is hypoactive delirium characterised?
Withdrawn, sleepy, quiet
What will a delirious person’s mood and affect be like?
Rapidly fluctuating
What sort of delusions might someone with delirium have?
Transient delusions that are often persecutory and ideas of reference. May be secondary to abnormal perceptions.
Differentials?
Dementia
Anxiety
Non-convulsive status epilepticus
Primary mental illness e.g. schizophrenia
How do you distinguish dementia and delirium?
Has there been an ACUTE change from cognitive baseline?
How do you distinguish non-convulsive status epilepticus?
EEG
How do you assess delirium (investigations etc.) broad categories
Informant history
Mental state assessment
Examine
Investigations
What do you need to ask in the informant history
Premorbid level of function
Onset and course of delirium
Drugs and alcohol use/abuse
What examinations should you do?
Neuro for FND
Evidence of infection or trauma- cardiac, resp, abdo…
What investigations?
Blood- FBC, ESR, U&E, LFT, TFT, Calcium, folate and B12, glucose, ?VDRL for syphilis, ?cultures?
MSU mandatory
CXR
Brain imaging? CT or MRI
Consider EEG if epilepsy a DD
Preventative measures for delirium?
Maximise orientation
Prevent causes (e.g. no polypharmacy, good analgesia)
Promote wellbeing e.g. socialising, visits from family and friends, activities to do like puzzles)
Management
Treat cause
Reorientate the patient- clocks and calendars, ensure they have their hearing aids and glasses
Try to avoid medication, but if a risk to own/others’ safety then can give typical antipsychotics
Would someone with delirium be taken to a psych ward?
No
What typical antipsychotics would you give to someone with delirium as a last resort?
Haloperidol 0.5-2mg
Chlorpromazine 50-100mg
PO if they will take it, or IM
Wait 20m to see if works, could give more.
When should you NOT give antipsychotics in a delirious patient?
If they have parkinson’s or Lewy Body Dementia
Should you ever use physical restraints in delirium?
No
Delirium increases the risk of which 4 things
Dementia
Mortality
Length of stay
New admission to long term care
Does delirium always resolve when the original illness does?
No, may persist. Don’t assume this is dementia, reassess 1-2m later.
