Delirium Flashcards
How is delirium defined?
an acute and fluctuating disturbance in the level of consciousness, attention and global cognition
the underlying mechanism is poorly understood, but involves neurotransmitter abnormalities and inflammation
Why is prompt treatment of delirium important?
to avoid potential brain damage
Who tends to be affected by delirium?
- it most commonly occurs in the elderly and very young
- 10% of patients over 65 show signs of delirium on admission to hospital
- it affects 15% of in-patients
What are the signs and symptoms associated with delirium?
- reduced level of consciousness
-
psychiatric symptoms
- disorientation (time / place /person)
- inattention
- illusions / hallucinations
- altered personality
- mood disorders
- speech disorders
- lacking insight
How do symptoms of delirium change over time?
- symptoms fluctuate over the course of the day and tend to be worse at night
- patients may show signs of hyperactivity (typically in withdrawal states) or lethargy (common in hepatic encephalopathy)
What are the 5 different categories that can cause delirium?
- CNS causes
- drugs (or withdrawal)
- endocrine causes
- infection / injury
- metabolic causes
What are the CNS causes of delirium?
- stroke
- abscess
- tumour
- subdural haematoma
- this is a bleed between the dura mater and arachnoid mater
What drugs (or withdrawal of) are associated with delirium?
- anticholinergics
- antiemetics
- antipsychotics
- corticosteroids
- digoxin
- levodopa (used to treat Parkinson’s)
- tricyclic antidepressants
- opioids
- alcohol
What common infections / injuries are associated with delirium?
- encephalitis and meningitis
- pneumonia
- sepsis
- UTI
- burns
- hypothermia
What are the metabolic causes of delirium?
- acid-base disturbance
- hepatic encephalopathy
- uraemia
- hypo / hyperglycaemia
- electrolyte abnormalities
- thiamine / vitamin B12 deficiency
What other things can cause delirium?
- post-operative states
- other mental disorders
- sleep depravation
What type of history is needed to diagnose delirium?
a collateral history
- this is needed to determine whether changes in mental status are recent
- and need to determine the patient’s normal level of functioning
How does delirium compare to dementia?
- in dementia, the memory problems are more likely to be chronic with a gradual onset
- patients with dementia are less likely to have inattention or impaired level of consciousness until the later stages of disease
What are 2 other important factors to consider when taking a history for delirium?
- drug history
- consider any with CNS effects or new additions as a potential cause
- alcohol history
What assessment and diagnostic tool can be used in the diagnosis of delirium?
- a mini mental state examination can show deficits in attention
- the Confusion Assessment Method (CAM) states the following features are diagnostic:
- acute change in cognition which fluctuates during the day
- inattention
- disturbance of consciousness
- disorganised thinking
