Delirium Flashcards
What proportion of elderly patients who are admitted to hospital are affected by delirium?
30%
What are 5 predisposing factors to delirium?
- Age >65 years
- Background of dementia
- Significant injury e.g. hip fracture
- Frailty or multimoridity
- Polypharmacy
What are 7 key precipitating events for delirium (which may be multifactorial)?
- Infection: particularly UTIs
- Metabolic: hypercalcaemia, hypoglycaemia, hyperglycaemia, dehydration
- Change of environment
- Any significant cardiovascular, respiratory, neurological or endocrine condition
- Severe pain
- Alcohol withdrawal
- Constipation
What are 7 types of clinical features which delirium may present with?
- Memory disturbance (loss of short term > long term)
- May be very agitated or withdrawn
- Disorientation
- Mood change
- Visual hallucinations
- Disturbed sleep cycle
- Poor attention
What are the 3 cardinal, defining features of delirium?
- fluctuating mental status
- disordered attention
- disorganised thinking or altered consciousness
What are 3 types of dementia?
- Hyperactive
- Hypoactive
- Mixed
What are 3 key aspects of the management of delirium?
- Treatment of underlying cause
- Modification of the environment
- Medical management: haloperidol or olanzapine
What does the Royal College of Physicians suggest is the first line medical treatment for delirium, if indicated?
Haloperidol 0.5mg
Which condition is it particularly important to be wary of when considering prescribing antipsychotics for delirium and why?
Parkinson’s disease - antipsychotics can oten worsen symptoms
What are 2 things to consider doing when a patient requires urgent treatment for delirium and has a background of Parkinson’s disease?
- careful reduction of Parkinson medication may be helpful
- if symptoms require urgent treatment, atypical antipsychotics quietiapine and clozapine are preferred
What are 5 factors which favour a diagnosis of delirium over dementia?
- impairment of consciousness
- fluctuation of symptoms: worse at night, periods of normality
- abnormal perception e.g. illusions and hallucinations
- agitation, fear
- delusions
What are 5 environmental factors that can be changed to help treat delirium?
- Re-orientation of patient by staff, family and sitters
- Provide glasses, hearing aids, clocks and calendars
- Remove non-essential lines and tubes
- Quiet, uninterrupted sleep at night
- Stimulation (but not too much) during day time
When medication is prescribed to treat delirium, what effect is it actually having?
will not improve cognition, but can reduce behavioural disturbance
What routes can haloperidol be given? 2
orally or IM
How is it recommended that repeated doses of haloperidol are given in delirium?
- lowest possible dose e.g. 0.5-1mg, tapering down as delirium clears
- 0.5mg every 30min until agitation is controlled
