Delirium Flashcards
Define delirium?
- Acute, fluctuating change in mental status
- With inattention, disorganised thinking and altered levels of consciousness
- Life-threatening with high morbidity and mortality
What is the difference between mortality and morbidity?
- Morbidity
- Diseased state, disability or poor health
- Mortality
- Measure of number of deaths
Read these presentations of delirium
What characteristic parameter is used to diagnose delirium?
Name some key components of it
- DSM-5 (2013)
- Disturbance in attention and awareness
- Develops over short time, flutctuates throughout the day
Name some differentials for delirium?
- Dementia
- Dysphasia
- Depression
- Developing withdrawal
Define Dysphasia?
Define Dysphagia?
- Dysphasia
- Deficiency in generating speech
- Dysphagia
- Deficiency in swallowing
Describe the relationship beteen Delirium and Dementia?
- Delirium is a strong risk factor for the subsequent development of dementia
- Delirum can worsen symptoms of dementia
Describe how Delirium can be differentiated from Dementia (Alzheimer’s)?
*** possible exam question
Describe some of the challenges when trying to differentiate between delirium and dementia?
- Severe dementia can look like delirium
- Dementia with Lewy bodies
- Inattention, visual hallucinations, fluctuations, altered arousal
- Mild delirium
- May only have a cognitive deficit
- Behavioural and psychological symptoms of dementia
How can uncertainties with delirium vs dementia be overcome
- Informant history and observation over time
- Involvement of MDT and specialists
Name 4 groups of patients where delirium often occurs?
- From most common to least:
- Intensive care
- Post-operative
- Hip fracture
- Medical inpatients
What is used for the diagnosis of delirium?
- DSM diagnostic criteria
- 4AT screening test
- Short screening tools
- Short confusion assessment method
- SQID
Describe ths short confusion assessment method?
- Acute onset + Inattention +/- Fluctuating course
- AND
- Altered consciousness OR Disorganised thinking
Describe the 4AT screening test?
- Alertness
- AMT4
- Attention
- Acute change/ fluctuating course
- Maximum 12 points
Describe what the scores from the 4AT screening test for delirium mean?
- >=4
- Possible delirium +/- cognitive impairment
- 1-3
- Possible cognitive impairment
- 0
- Delirium or severe cognitive impairment unlikely
Describe the Alertness component of the 4AT screening test?
- Observe patient
- If asleep, attempt to rouse them
- Ask them to state their name and address
- Normal alertness = 0
- Mild sleepiness <10 seconds after waking = 0
- Clearly abnormal = 4
Describe the AMT4 component of the 4AT screening test?
- Age, DOB, location, current year
- No mistakes = 0
- 1 mistake = 1
- 2 or more mistakes = 2
Describe the Attention component of the 4AT screening test?
- Please tell me the months of the year in backwards order?
- Assist with ‘What is the month before December?’ if required
- 7+ months = 0
- <7 months = 1
- Untestable = 2
Describe the Acute change or fluctuating course component of the 4AT test?
- Evidence of significant fluctuation in alertness, cognition or other mental function (paranoia, hallucinations) arising over the last 2 weeks and still evident in last 24 hours
- No = 0
- Yes = 4
Describe SQID?
- Single question in delirium
- Has X been more confused recently?
Name some visual cues that can assist a doctor in diagnosing delirium?
- Floccillation - plucking at the air
- Low sensitivty, very high specificity
- Carphology - aimlessly picking at bedclothes
What can factors can result in a missed diagnosis of delirium?
- Not looking for it
- Older age
- Sensory impairments (deaf)
- Frailty
What are the categories of predictors of delirium?
Give examples from each
- Personal factors
- Male
- Older age
- Dementia
- Depression
- Environment factors
- Polypharmacy
- Surgery
- Dehydration
What are the predisposing factors for delirium?
- Personal predictors
- Male
- Older age
- Dementia
- Depression
What are the precipitating factors for delirium?
- Environmental risk factors
- Polypharmacy
- Surgery
- Dehydration
Name some medical factors which can cause delirium?
- Pain
- Hypoxia
- Infection
- Constipation
- Sleep disturbance
Name some consequences for delirium?
- Increased mortality
- Increased falls risk
- Increased length of hospital stay
- Increased risk of future dementia
Describe the HELP programme for delirium in hospitals?
HELP = The hospital elder life program
- Targets key delirium risk factors
- Dehydration
- Sensory loss
- Immobility
- Use of sedatives
- Cogntivie re-orientation programme
- Delivered by elder life specialists and trained volunteers
Describe the TIME bundle in delirium?
- Guides deliriun risk reduction
- Triggers
- Investigate
- Manage
- Engage
Describe the management of agitation and distress within delirium?
- Non-pharmacological
- Look for acute cause (thirst, pain, hunger, constipation)
- Repeated re-orientation
- Reassurance
- Pharmacological (only if required)
- Antipsychotics
- Haloperidol, risperidone
- Lorazepam
- Antipsychotics
