Delirium

Question 1

What is delirium?

Answer 1

Acute transient CNS disorder leading to impaired fluctuating consciousness and inattention

Question 2

What are types of delirium?

Answer 2

Hypoactive:
Lethargy, reduced motor activity, apathy, sleepiness

Hyperactive:
Agitation, irritability, restlessness, aggression
Hallucinations and delusions

Mixed

Question 3

What are causes of delirium?

Answer 3

Hypoxia
Endocrine
Infection
Stroke - rasied ICP
Nutritional - B12 deficiency, thiamine deficiency
Theatre - post operative
Metabolic - hyponatraemia, hypoglycaemia
Constipation
Urinary retention
Alcohol withdrawal
Drugs - benzodiazepines, opioids, anticholinergics

Question 4

What are features of delirium?

Answer 4

Inattention - inabiltiy to focus
Impaired consciousness
Memory disturbaces (short term> long term)
Disorientation - time person, place
Disturbed sleep cycle
Visual hallucincations
Mood change
Fluctuating course

Question 5

What are differences between dementia and delirium in:
Sleep wake cycle
Attention
Arousal
Autonomic features
Duration
Delusions
Course
Consciousness
Hallucination
Onset 
Psychomotor activity

Answer 5

Delirium
Disrupted sleep cycle
Inattention
Increased/decreased arousal
Abnormal autonomics
Hours to weeks
Fleeting delusions
Fluctuating course
Reduced consciousness
Common hallucinations
Acute onset
Abnormal psychomotor activity

Question 6

What investigations in delirium?

Answer 6

Urinalysis 
FBC - infection
CRP - infection
Blood culture - infection
U&E - electrolytes
Glucose
LFT - alcohol. liver disease
Calcium
B12/folate
ECG
MSU MC&S
ABG, T head
LP
EEG

Question 7

What assessment methods for delirium?

Answer 7

Abbreviated mental test

Confusion assessent method

Question 8

What is the AMT?

Answer 8

Age
Time
Recall address
What year?
Where are you
Who am I
DOB
Frist world war
Current monarch
Count backwards from 20 to 1

Question 9

What is the CAM?

Answer 9

Acute onset and fluctuating course
Inattention - 7 subtract test
Disorganised thinking
Altered consciousness

Question 10

What is mx for delirium?

Answer 10

Treat underlying cause - infection, electrolytes, drugs,laxative for faecal impaction, catheterise for retention, analgesia for pain

Reassure and re-orientate
Regular reminders of time, place, day and date
Reassure

Appropriate environment
Quiet, well lit side room
Optimise senses - glasses, hearing aids
Consistency in caring staff
Reassuring nursing staff
Presence of family/friend

Question 11

How do you manage disturbed, violent or distressed behaviour?

Answer 11

Oral intake
Continence

Oral low dose haloperidol

Avoid benzos