Delirium

Question 1

What should be the initial approach to screening for delirium in high-risk patients?

A) Single Question in Delirium (SQID)
B) AMT4
C) AMTS
D) MOCA
E) MMSE

Answer 1

A) Single Question in Delirium (SQID)

Simply ask yourself, their family or carers one question: “Is this patient more confused than before?”

Question 2

Which of the following is the established screening tool for delirium in patients with acute confusion?

A) MMSE
B) MOCA
C) Single Question in Delirium (SQID)
D) AMTS
E) AMT4

Answer 2

E) AMT4

This test looks at some key diagnostic criteria absent in the other tests, e.g. attention, concentration and consciousness.

Question 3

True or false: Delirium is a state of acute confusion.

Answer 3

False.

There is more to delirium than simply being acutely confused. For deliirium to be diagnosed there needs to be an acute disturbance in in attention (reduced ability to direct, focus, sustain and shift attention) and awareness (reduced orientation to environment). There is also an additional disturbance in cognition.

Question 4

Delirium can be separated into two subgroups. What are they?

Answer 4

Hypoactive and hyperactive

Question 5

What are some differentials for delirium?

Answer 5

Dementia

Depression

Non-convulsive epilepsy

Psychotic illness

Question 6

Why do we check for epithelial cells in urine microscopy and culture?

Answer 6

To check for sample contamination - skin contact will leave epithelial cells so check this on the reported results.

Question 7

What are the main causes of delirium?

Answer 7

“PINCH ME”

Pain
Infection
Nutrition
Catheter/constipation
Hydration

Metabolic/medications
Environment

Question 8

You have an agitated patient with delirium on the ward. You have tried non-drug measures, prevention and de-escalation but all these attempts have failed. You are considering using a medical intervention next.

What drug and dose would you consider first?

Answer 8

Lorazepam 0.5-1mg orally

If absolutely necessary, IM lorazepam at the same dose.

*If already taking benzos or at risk of respiratory depression, you could use haloperidol (if no Parkinson’s, dementia with Lewy bodies or prolonged QTc)