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Psychiatry > Delirium > Flashcards

Delirium Flashcards

1
Q

Delirium is…

A

a neuropsychiatric syndrome

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2
Q

is the most common health problem in

A

hospitalised patients over 65, also affects very young

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3
Q

Delirium is defined as…

A

acute and fluctuating disturbance in level of consciousness, attention and global cognition

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4
Q

risk factors for developing delirium

A 
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
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5
Q

symptom acronym for delirium

A 
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
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6
Q

features of hyperactive delirium

A

agitation, incoherent speech, disorganised thoughts, delusions, hallucinations, disorientation

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7
Q

features of hypoactive delirium

A

confusion, sedation, withdrawn, quiet, sleepy, appears unmotivated/lazy, often misdiagnosed as depression

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8
Q

features of mixed delirum

A

fluctuating symptoms of both types, most common, features worse at night (reversed sleep cycle)

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9
Q

what is the onset of delirium

A

rapid

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10
Q

what is the duration of delirium

A

can last hours/days to weeks/months

mean is 1-4 weeks

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11
Q

complications associated with delirium

A

increased mortality

increased hospital stay, increased hospital acquired complications, increased incidence of dementia, falls

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12
Q

CNS causes of delirium

A

Stroke, abscess, tumour, subdural haematoma, epilepsy, meningitis, encephalitis

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13
Q

systemic infectious causes of delirium

A

pneumonia, UTI, malaria, wounds, IV lines,

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14
Q

cardiac causes of delirium

A

MI, PE, cardiac failure, hypoxia

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15
Q

drug causes of delirium

A

opiates, anticonvuslantas, levodopa, sedatives, recreational, post-GA, alcohol withdrawal

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16
Q

endocrine causes of delirium

A

Hyperparathyroidism, hyper/hypothyroidism, diabetes

17
Q

urinary causes of delirium

A

UTI, renal failure, urinary retention , presence of catheters

18
Q

metabolic causes of delirium

A

Acid-base disturbance, hepatic encephalopathy, uraemia, hypo/hyperglycaemia, electrolyte abnormalities, thiamine/vitamin B12 deficiency, poryhyria,

19
Q

Environmental factors of delirium

A

moving wards, changing environments, sleep deprivation

20
Q

Diagnosis of delirium

A

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

21
Q

Formal cognitive tests

A 
CAM 
4ATs
MMSE
ACE-R
MoCA
22
Q

CAM cognitive test

A
  1. Acute onset and fluctuating course
  2. inattention
  3. disorganised thinking
  4. altered level of consciousness
    Delirium = 1+2+either 3 or 4
23
Q

4ATs cognitive test

A 
Alertness
Abbreviated mental test (age, DOB, place, current year)
Attention (months of year backwards)
Acute change or fluctuating course 
Delirium =>4
24
Q

Management of delirium

A 
prevention
identify and reverse all underlying causes
manage environment and provide support
prescribe
review
25
Q

factors to manage environmental and provide support

A

educate, constant communication, minimal staff changes, reality orientation (clear communication, clock, calender), correct sensory impairments (glasses and hearing aids), move to a bright side room, noise reduction, unsfae objects removed, food, watr, warmth, symptom control, assess capacity, watch for renal disease

26
Q

medical management of delirium

A

HALOPERIDOL 0.5-5mg orally then IM, up to 10mg in 24 hours
LORAZEPAM (not diazepam) 0.5-2mg, up to 2x in 24 hours

Sedating drugs can worsen alcohol withdrawal - reducing scale or benzodiazepines: chlordiazepoxide, diazepam

27
Q

pathophysiology of delirium

A

altered level of neurotransmitters
neuronal membrane doesn’t depolarise
inflammatory cytokines interfere with neurons
direct toxic insults to brain and aberrant stress responses probably contribute

28
Q

Comparison to dementa

A

Onset - sudden vs gradual
consciousness - variation vs impaired
attention - impaired vs preserved
psychomotor changes vs normal

Psychiatry (11 decks)

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