Delirium Flashcards
What is delirium?
Delirium is an acute, transient, global organic disorder of CNS functioning, resulting in impaired conciousness and attention
What are the different type of delirium?
- Hypoactive
- Hyperactive
- Mixed
What causes delirium?
Delirium has a number of causes, however most cases are multifactorial
What are the categoies of causes of delirium?
- Hypoxic
- Endocrine
- Infection
- Stroke and other intracranial events
- Nutritional
- Post-operative
- Metabolic
- Abdominal
- Alcohol
- Drugs
- Others
What are the hypoxic causes of delirium?
- Respiratory failure
- Myocardial infarction
- Cardiac failure
- Pulmonary embolism
What are the endocrine causes of delirium?
- Hyperthyroidism
- Hypothyroidism
- Hyperglycaemia
- Hypoglycaemia
- Cushing’s
What are the infectious causes of delirium?
- Pneumonia
- UTI
- Encephalitis
- Meningitis
What are the intracranial causes of delirium?
- Stroke
- Raised ICP
- Intracranial haemorrhage
- Space-occupying lesions
- Head trauma
- Epilepsy
- Intracranial infection
What are the nutritional causes of delirium?
- Thiamine deficiency
- Nicotinic acid deficiency
- Vitamin B12 deficiency
What are the post-operative causes of delirium?
- Anaesthetic
- Opiate analgesics
- Post-operative complications
What are the metabolic causes of delirium?
- Electrolyte disturbance
- Hepatic impairment
- Renal impairment
What are the abdominal causes of delirium?
- Faecal impaction
- Malnutrition
- Urinary retention
- Bladder catheterisation
What are the alcohol-related causes of delirium?
- Intoxication
- Withdrawal
What drugs can cause delirium?
- Benzodiazepines
- Opiods
- Anticholinergic
- Anti-Parkinsonian medications
- Steroids
What are the other causes of delirium?
- Severe pain
- Sensory deprivation, for example leaving the person with spectacles or hearing aids
- Relocation
- Sleep deprivation
What are the risk factors for delirium?
- Hospital admission (delirium occurs in 15-20% of general admissions to hospital)
- Older age (65 or over)
- Multiple co-morbidities
- Dementia (2/3 of cases occur in inpatients with pre-existing dementia)
- Physical frailty
- Renal impairment
- Male sex
- Sensory impairment
- Previous episodes
- Recent surgery
- Severe illness
Describe the course of delirium?
Delirium has an acute onset, and takes a fluctating course, often worse at night
What are the symptoms of delirium?
- Disorganised thinking, e.g. slowed, irrational, or incoherent thoughts
- Euphoric, fearful, depressed, or angry
- Language impaired, e.g. rambling speech, repetitive, disruptive
- Illusions, delusions, and hallucinations
- Reveral of sleep-wake pattern
- Inattention
- Unaware/disorientated
- Memory deficits