Delirium Flashcards
Delirium is…
a neuropsychiatric syndrome
is the most common health problem in
hospitalised patients over 65, also affects very young
Delirium is defined as…
acute and fluctuating disturbance in level of consciousness, attention and global cognition
risk factors for developing delirium
elderly dementia previous episode perioperative - long surgery, emergency, medications extremes in sensory experience existing sensory deficits immobility social isolation depression polypharmacy co-morbidity post-op - fatigue terminal illness alcohol dependency malnutrition
symptom acronym for delirium
Disordered thinking: slow irrational, rambling, jumbled up, incoherent ideas Euphoric, fearful, depressed or angry Language impaired: speech reduced, gabbling, repetitive and disruptive Illusions/delusions/hallucinations Reversal of sleep awake cycle Inattention Unaware/disorientated Memory deficits
features of hyperactive delirium
agitation, incoherent speech, disorganised thoughts, delusions, hallucinations, disorientation
features of hypoactive delirium
confusion, sedation, withdrawn, quiet, sleepy, appears unmotivated/lazy, often misdiagnosed as depression
features of mixed delirum
fluctuating symptoms of both types, most common, features worse at night (reversed sleep cycle)
what is the onset of delirium
rapid
what is the duration of delirium
can last hours/days to weeks/months
mean is 1-4 weeks
complications associated with delirium
increased mortality
increased hospital stay, increased hospital acquired complications, increased incidence of dementia, falls
CNS causes of delirium
Stroke, abscess, tumour, subdural haematoma, epilepsy, meningitis, encephalitis
systemic infectious causes of delirium
pneumonia, UTI, malaria, wounds, IV lines,
cardiac causes of delirium
MI, PE, cardiac failure, hypoxia
drug causes of delirium
opiates, anticonvuslantas, levodopa, sedatives, recreational, post-GA, alcohol withdrawal
endocrine causes of delirium
Hyperparathyroidism, hyper/hypothyroidism, diabetes
urinary causes of delirium
UTI, renal failure, urinary retention , presence of catheters
metabolic causes of delirium
Acid-base disturbance, hepatic encephalopathy, uraemia, hypo/hyperglycaemia, electrolyte abnormalities, thiamine/vitamin B12 deficiency, poryhyria,
Environmental factors of delirium
moving wards, changing environments, sleep deprivation
Diagnosis of delirium
history and full examination
Formal cognitive tests
Identify cause - urine analysis, FBCs, U&Es, LFTs, thyroid function, glucose, CRP, B12 and folate, CXR, MRI/CT, EEG
Formal cognitive tests
CAM 4ATs MMSE ACE-R MoCA
CAM cognitive test
- Acute onset and fluctuating course
- inattention
- disorganised thinking
- altered level of consciousness
Delirium = 1+2+either 3 or 4
4ATs cognitive test
Alertness Abbreviated mental test (age, DOB, place, current year) Attention (months of year backwards) Acute change or fluctuating course Delirium =>4
Management of delirium
prevention identify and reverse all underlying causes manage environment and provide support prescribe review
