Delirium

Question 1

How would you describe the key characteristics of delirium

Answer 1

– An acute confusional state.
- common in over 65’s
– state of rapidly fluctuating alterations of consciousness and cognition
– illusions and mood changes
-May indicate serious underlying illness which is causing the delirium

Question 2

What is the epidemiology of delirium?

Answer 2

-Affect the elderly over 65
-One in eight in patients
Most common acute disorder in hospitals

Question 3

What are the risk factors of delirium?

Answer 3

– Over the age of 65
– past/present cognitive impairment and/or dementia
-Current hip fracture
– Severe illness – a clinical condition that is deteriorating or is at risk of deterioration
– – – – – –/, hip fracture, vascular illness, terminal illness

Question 4

Describe the cause of delirium neurochemically

Answer 4

– Dopamine Excess
– ACh reduction?
– Effects of medications (polypharmacy)
– results from excessive neurotransmitter release and abnormal signal conduction

Question 5

What underlying causes should you think about when suspecting delirium

Answer 5

– Pinch me
– pain, infection, constipation, hydration, medications, environment (orientation)
– drugs
– infection: UTI/chest infection

Question 6

Name the three subtypes of delirium and their characteristics

Answer 6

1. hyperactive subtype – agitation, delusions and disorientation: confused with schizophrenia
2. hypoactive subtype- Apathy and quiet confusion.this type may be confused with depression
3. mixed subtype – patients vary from hypoactive hyperactive

Question 7

Name some signs that would indicate or suggest delirium

Answer 7

– Recent/rapid onset (hours/days)
– changes/fluctuations in behaviour
– cognitive symptoms: worsened concentration, slow responses, confusion, disorientation to time and in severe cases place and person, poor short-term memory
– visual/auditory hallucinations
– physical: breathlessness, agitation, changes in appetite, sleep disturbances
-Social changes,: withdrawal lack of cooperation and alterations in Mood and attitude
– reduced awareness/consciousness

Question 8

Name the investigations you would want to carry out in a patient with delirium

Answer 8

Clinical assessment will be based on DSM – V criteria or CAM Criteria (confusion assessment method)
– mental state examination
-Physical examination
– Infection screen: x-ray (Test), urine in dipstick
– urine culture, bloods
-ECG, glucose

Question 9

How would you want to treat delirium?

Answer 9

Treat the underlying calls
– –
Re-orientate the patient: explain who they are, where they are, and what my rollers
—
If the patient is distressed/a risk to themselves or others:

– use verbal and non-verbal deescalation techniques to manage the situation

• If these techniques do not work, consider haloperidol (short -term and lowest clinically appropriate dose)
• May need to use benzodiazepines for alcohol withdrawal
• If the Delirium does not resolve reassess for underlying causes/assess for dementia

Question 10

Name some ways in which delirium can be prevented

Answer 10

-Routine cognitive assessment and risk assessment within 24 hours of admission into hospital
– address disorientation: good lighting, clocks, calendars, avoid moving the patient, introduce activities that stimulate cognition , encourage family and friends to be present 
– Addressed dehydration and constipation
- Look for areas infection
– encourage patients to move around
– treat pain
– medications review
– address  sensory impairments: glasses
– promote good sleeping patterns

Question 11

What is the prognosis for a patient who has had delirium?

Answer 11

– Delirium is common and usually temporary
-Advise people and their families to get in touch if there are any sudden changes in behaviour
– complications may include: longest day in hospital and higher risk of complications