Delirium and Emergency Psychiatry - McIntyre Flashcards
delirium
MC elderly man in ICU
encephalopathy
delirium
acute brain failure
ICU psychosis
cerebral insufficiency
medical emergency
delirium
need to tx underlying cause
delirium
neuropsych syndrome
-specific cause
wax and wane
acute onset
hypoactive, hyperactive, mixed
withdrawal and non-withdrawal
delirium vs. dementia
dementia - neurocognitive disorder
dementia - progressive decline
delirium - acute onset
disease of disrupted attention
delirium
waxing and waning
in delirium
not dementia - except DLB - lewy body
vital sign disturbance
delirium
also - sleep wake cycle messed up
test of attention
serial 7
risk with delirium
risk fx for developing dementia
cause long term cognitive decline
poor prognosis
delirium
20-40% mortality next 12 months
NT in delirium
decreased ACh
increased DA
and others
causes of delirium
metabolic meds infections intox/withdarwal cerebrovasc disease pulmonary disease CV disease head trauma burns
tx of delirium
treat underlying cause
stop anticholinergic meds
low dose haloperidol
can increase QT interval - and decrease seizure threshold
anticholinergic meds
stop them with delirium
.no benzos
in delirium
-except alcohol/benzo withdrawal
olanzapine, clozapine, chlorpromazine
anticholinergic antipsychotics
do not give with delirium
prevention of delirium
sensory equip ok
encourage sleep cycle - melatonin
risk fx of violence
best predictor - previous hx of violence
hallucinations stated desire harm others antisocial/borderline substance use delirium major mild dementia head trauma
management of violence
empathy eye contact validate pt feelings enforce boundaries body language listening > talking
management of violent patient
safely escort pt to seclusion area
administer meds if necessary
physical restraints removed as soon as possible**
can never use restraints as punishment
restraints can lead to death - rhabdomyolysis, suffocation
always ask about
suicide
hospitalize against will if necessary
85% people at end of life
delirius
