delirium

Question 1

what is the syndrome of delirium?

Answer 1

acute onset (hrs/days)
fluctuating course
impaired attention, altered awareness
variety of cognitive and neuropsych disorders
not explained by another preexisting diorder
don’t appear in context of reduced arousal eg coma
evidence it is due to another condition or drug etc

Question 2

what are some predisposing factors for delirium?

Answer 2

dementia
cognitive, sensory or functional impairment
previous delirium
comorbidity
over 75
depression
alcohol misuse

Question 3

what are some precipitating factors for delirium?

Answer 3

drugs
physical restraints
bladder catheter
dehydration/electrolyte disturbance
infection
hip fracture
major surgery
pain
polypharmacy
constipation
any many more

Question 4

which neurotransmitters are implicated in delirium?

Answer 4

cholinergic deficiency

dopaminergic excess

Question 5

what are features of hyperactive delirium?

Answer 5

increased confusion
hallucinations/delusions
sleep disturbance
restless, agitated, aggressive

Question 6

what are features of hypoactive delirium?

Answer 6

poor concentration,
less aware,
reduced mobility/movement,
reduced appetite,
withdrawn, quiet, sleepy

Question 7

mixed delirium can occur, true or false?

Answer 7

true

Question 8

delirium diagnostic criteria

Answer 8

1 and 2 plus 3 or 4:

1. acute onset and fluctuating course
2. innatention
3. disorganised thinking
4. altered consciousness

Question 9

what are some bedside tests of attention?

Answer 9

count backwards from 20

count months of year forwards then backwards

Question 10

how can delirium be distinguished from a psychotic episode?

Answer 10

EEG:

psychotic: normal
delirium: encephalopathic with changes in brain waves

Question 11

how can delirium be distinguished from dementia?

Answer 11

in dementia alertness and attention are normally normal. gradual onset. generally normal perception, eg no hallucinations, delusions.

Question 12

how is delirium managed?

Answer 12

treat underlying cause
re-orientate - involve family, avoid moving around
don’t restrain
avoid catheters
promote normal sleep pattern - disourage napping in day
promote calm quiet environment

Question 13

when should pharmacological intervention be used?

Answer 13

patient is severely distressed
patient is a risk to themselves and others
patient requires urgent medical intervention

Question 14

what drugs can be used to manage delirium?

Answer 14

haloperidol, lorazepam