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Psychiatry > Delirium > Flashcards

Delirium Flashcards

1
Q

Psychiatric differential for acute behavioural disturbance

A

Delirium

Dementia (esp Lewy body)

Schizophrenia

Drug-induced psychosis

Delirium trements (alcohol withdrawal)

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2
Q

Onset in delirium vs dementia

A

Acute in delirium, insidious in dementia

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3
Q

Short-term course in delirium vs dementia

A

Fluctuating in delirium, constant/progressive decline in dementia

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4
Q

Attention in delirium vs dementia

A

Poor attention in delirium, relatively spared in dementia (clear consciousness, not drowsy)

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5
Q

Delusions and hallucinations in delirium vs dementia

A

More common, simple, and fleeting in delirium

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6
Q

Clinical features of delirium

A

Attention + awareness of surroundings impaired

Behaviour: Irritable/agitated, or somnolence + reduced activity

Consciousness: clouded, impaired concentration, disorientation in time + place

Delusions: Transient persecutory +/- visual hallucinations

Fluctuating, often worse at night

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7
Q

Simple screening tools for delirium

A

Months of the year backwards

AMTS

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8
Q

Questions in the AMTS

A
  1. Age
  2. DOB
  3. Recall 42 West street
  4. Time
  5. Current year
  6. Place
  7. Person
  8. Current monarch
  9. Year of WW2
  10. Count backwards 20 to 1
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9
Q

% of delirium where drugs implicated

A

1/3 of cases

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10
Q

Differential for confusion/memory loss

A

Deafness/dysphasia

Dementia

Delirium

Post-ictal state (epilepsy, complex partial seizure)

Drugs (esp anticholinergics)

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11
Q

Predisposing factors for delirium

A
  • Demographic: Elderly, male
  • Neurological Hx: Dementia, sensory impairment
  • PMHx: Frailty/immobility, Hx of delirium
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12
Q

Psychiatric drugs commonly causing delirium

A

Tricyclic antidepressants

Lithium

Benzodiazepines, sedatives (paradoxical agitation in young males)

Benzodiazepine withdrawal

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13
Q

Cardiac drugs commonly causing delirium

A

Diuretics

Digoxin

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14
Q

Other drugs commonly causing delirium

A

Alcohol + alcohol withdrawal

Opiates

Steroids

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15
Q

Neurological conditions causing delirium

A

Epilepsy (post-ictal)

Space-occupying lesion (e.g. tumour, haematoma)

Head injury

Encephalitis, abscess

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16
Q

Medical conditions causing delirium

A

Systemic: sepsis, dehydration, constipation

Trauma: Post-op, burns, hypoxia, poor pain control

Endocrine: Hyperthyroidism, Addisonian crisis, deranged PTH

Autoimmune: SLE

Metabolic: Liver/renal failure, deranged U&Es, hypoglycaemia (esp if diabetic)

17
Q

Environmental components in management of delirium

A

Quiet room with clock and good lighting

Few, named staff

Regular routine

Capacity assessment

18
Q

Investigations for delirium

A
  • Bloods: FBC, U&E, LFT, glucose, cultures
  • O: MSU + culture
  • X: CXR
  • ECG
  • Polypharmacy drug review
19
Q

Medical managment of delirium

A
  • Assess nutrition, hydration, O2 sats
  • Assess mobility, bowel habits, urinary frequency
  • Infection screen
  • Review medication
  • Pharmacological intervention if necessary
20
Q

Pharmacological options for delirium

A

Lorazepam (or other benzo) as first-line (0.5-1mg) if acutely disturbed

Olanzapine/haloperidol if necessary, but not within 1h

Hypnotic for sleep disturbance

Check local trust guidelines

21
Q

2-4 year mortality followng delirium in >65

A

55%

22
Q

Indications for antipsychotics in delirium

A

Risk to self/others

Distress from hallucinations

23
Q

Indication benzodiazepine in delirium

A

Acute behavioural disturbance/agitated patient

24
Q

Onset of lorazepam

A

15-30 min

25
Q

Max dose lorazepam per 24h

A

4mg

26
Q

Typical lorazepam doses

A

0.5-1mg 4-hourly for PRN

1-2mg for sedation

27
Q

Alternative to IM lorazepam if compromised respiratory function/sensitivity or tolerance to BDZs

A

50mg promethiazine IM

28
Q

Physical observations following tranquilization

A

Every 15 mins for 1 hr

Every hour for 4 hours

4-hourly for 24 hours

Watch out for respiratory depression

29
Q

Antidote for benzodiazepines

A

Flumazenil

Psychiatry (20 decks)

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