Delirium

Question 1

what are the key features of delirium?

Answer 1

disturbed consciousness (hyperactive/ hypoactive/ both)
change in cognition (hallucinations/illusions/memory/language/perceptual)
acute onset and fluctuant 

others:
change in sleep / wake cycle
emotional disturbance
disturbed psychomotor behaviour

Question 2

what can precipitate delirium?

Answer 2

infection
dehydration
constipation 
alterations in medications
injury 
biochemical disturbance
pain
hypoxia
alcohol/drug withdrawal 
sleep disturbance 
brain injury 
change in environment
change in social circumstances

Question 3

what criteria is used to diagnose delirium?

Answer 3

4AT score

Alertness
4AMT (location, age, d.o.b, year)
Attention
acute onset and fluctuation

Question 4

what are the non-pharmacological managements for delirium?

Answer 4

promote continuity of care (don’t move wards etc)
discharge from hospital if possible
reorientate/familiarise patient i.e. with use of family
early mobility
avoid catheterisation

Question 5

what is the pharmacological management for delirium and when should it be used?

Answer 5

15mg quetiapine

used if failed non-pharmacological measures and/or danger to themselves

Question 6

how can delirium be prevented?

Answer 6

avoid constipation
avoid dehydration 
reassess medications 
ensure use of aids such as hearing aids and glasses 
promote good sleep/wake cycle 
prevention, early identification and treatment of post op complications
regulation of bladder/bowel control 
pain control

Question 7

what are the main consequences from delirium?

Answer 7

increased risk of further delirium
increased risk of developing dementia
high mortality rate in the next year

Question 8

a patient is admitted to the geriatric ward with delirium.

what do you do to manage this patient?

Answer 8

treat cause

• full Hx and examination
• TIME bundle

explain diagnosis

pharmacological/non-pharmacological measures

Question 9

what is involved in the TIME bundle for a patient with delirium?

Answer 9

T- think, exclude and treat possible triggers

I- investigate and intervene to correct underlying causes

M - management plan

E - engage and explore