Question 1

Delirium

Accepted Answer

Delirium is a reversible, acute-onset condition that typically develops over a short period of time and results in fluctuating and transient global cognitive dysfunction.

Question 2

Core diagnostic criteria of delirium

Accepted Answer

- Acute onset and fluctuation (hallmark feature): certain types of delirium are more prone to hyperactive or hypoactive states; period of somnolence to excessive alertness, agitation, frenzied excitement. short period (hours to few days); - Disturbance of attention and awareness: often unable to maintain a coherent stream of thought or action and can be highly distractible and inattentive. - Other cognitive impairments: e.g., memory impairment, visuospatial and or perceptual impairments (illusions)

Question 3

Pathophysiological causes of delirium

Accepted Answer

neurotransmitter system dysfunction CNS response to inflammatory processes hypothalamic pituitary adrenal axis dysregulation direct cerebral insult/injury (e.g. diffuse brain injury, hypoxia)

Question 4

Neurotransmitters involved in delirium

Accepted Answer

Acetylcholine plays a role in attention, memory, and arousal - decrease in acetylcholine most likely contributes to impairments in attention and memory disturbance. physostigmine (eserine) --> will reserve the effects of acetylcholine drug overdose. Excess dopamine or enhanced receptor site sensitivity is thought to be the cause of hallucinations. Bupropion can exacerbate delirium since it's a dopamine re-uptake inhibitor and cause hallucinations, paranoia, and/or confusion. Dopamine antagonists and antipsychotics are used to treat delirium. Disruption or over excitation of serotonergic (serotonin) systems may cause hallucinations and emotional lability (e.g., hallucinogen intoxication).

Question 5

Predisposing Factors of delirium

Accepted Answer

Older age dementia severity of physical/chronic illness, polypharmacy metabolic disturbances depression sensory loss or dysfunction, respiratory failure or myocardial infarction infections comorbid problems (e.g., sleep deprivation, sensory impairment, immobility, functional decline, dehydration, or poorly managed pain) Low cognitive reserve --> lowers the threshold for neurocognitive changes.

Question 6

Precipitating Factors of delirium

Accepted Answer

Surgeries (e.g., valve, CABG, repair of the bone -- all increase risk of metabolic complications). Drug side effects (e.g., calcineurin inhibitors like Prograf) Drug withdrawal infections iatrogenic complications

Question 7

Is delirium life threatening?

Accepted Answer

Yes. If not identified or treated properly, patients can die or sustain permanent, debilitating medical or cognitive outcomes. Thus, all types of delirium are treated seriously, and patients typically require 24-hour monitoring such as that provided on the ICU or specialized hospital units.

Question 8

Assessment domains of delirium

Accepted Answer

Tools that assess basic, sustained, and divided attention should be stressed. Brief assessment at different times of day is recommended to track waxing and waning confusion.

Question 9

Environmental interventions for delirium

Accepted Answer

frequent orientation, cueing, and reassurance use of large clocks and calendars placing familiar objects in the room quiet, well-lit surroundings night lights windows to help with time of day having glasses and hearing aids available to improve sensory quality avoidance of restraints and preference for one-on-one safety observers presence of familiar faces and use of collateral support

Question 10

Medication classes commonly associated with delirium:

Accepted Answer

tricyclic antidepressants, anticholinergics, benzodiazepines, corticosteroids, H2-receptor antagonists, sedative hypnotics, anticonvulsants, antiparkinsonian drugs, anti- inflammatories, and chemotherapy drugs.

Question 11

Serotonin syndrome

Accepted Answer

Typically caused by the conjoint use of multiple serotonergic agents. In the early stages, it can be marked by mental status changes, agitation, myoclonus, hyperreflexia, diaphoresis (sweating), tremor, diarrhea, incoordination, and fever. If left untreated and medications continue, death can occur. tremor and diarrhea most common initially Treatment requires the discontinuation of all serotonergic drugs and close monitoring with an expectation for improvement within 24 hours.

Question 12

Primary symptoms required for a diagnosis of delirium tremens (DTs)

Accepted Answer

confusion, autonomic hyperactivity, hallucinations

Question 13

Severe sepsis has been most commonly associated...

Accepted Answer

white matter compromise secondary to ischemic lesions

Question 14

Neuroleptic malignant syndrome (NMS)

Accepted Answer

A rare complication following neuroleptic use marked by muscle rigidity, pallor (pale skin), dyskinesia (involuntary motor movement), hyperthermia, incontinence, unstable blood pressure, tachycardia, and pulmonary congestion. fever, increased blood pressure, and stiffness in his extremities Treatment requires discontinuation of neuroleptics, intravenous hydration, and close monitoring of vital signs and mental status.

Question 15

Side effects of Levodopa can include:

Accepted Answer

delirium marked by hallucinations, confusion, and increased agitation Parkinson medication

Question 16

Hallucinations in delirium vs. schizophrenia/psychosis

Accepted Answer

Delirium: - hallucinations can be both formed (shapes, objects, people) and unformed (flashing lights, spots) in delirium Psychosis: - hallucinations are typically formed (e.g., distinct shapes, objects, people, or scenes) - tend to be more auditory Both: - bizarre hallucinations can occur in both - it is rare for them to vacillate between visual, tactile, and auditory in one individual.

Question 17

Delirium following discontinuation of long-term benzodiazepines is most similar to withdrawal from ???

Accepted Answer

Alcohol. Benzodiazepines and alcohol target similar receptors. Not surprisingly, discontinuation of long-term benzodiazepines results in withdrawal symptoms similar to withdrawal from alcohol. This is also why long-acting benzodiazepines are typically used to treat AWS.

Question 18

Locked in syndrome

Accepted Answer

occurs when there is focal injury to the brainstem (usually vascular lesion in the ventral pons due to basilar artery occlusion) and the patient cannot move but retains conscious awareness and volitional vertical gaze and eyelid movement.

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Delirium and Disorders of Consciousness Flashcards

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