Delirium (ICU) Flashcards
What is delirium
A clouding of consciousness, disturbance of cognition, at least ones form of psychomotor disturbance, disrupted sleep-wake and rapid onset and fluctuations
Complex PTSD more common in…
Past psychotic hx
Hx of cPTSD
Hx of anxiety or depression
Dementia
Most prevalent type
Hypoactive
Assessment
CAM and CAM ICU
Features of the CAM assessment
Acute onset and fluctuating course AND Inattention PLUS disorganised thinking OR altered level of consciousness
High risk factors for delirium
Illness severity
Hospital exposures
Cerebral metabolic insufficiency
Peripheral and/ or neuroinflammation
Neurotransmitter and neuroanatomical substrate imbalances
Predisposing factors
Smoking
Hypertension
Cardia disease
Premorbid dementia
Older age
Multiple comorbidities
Psychoactive drug use
Poly pharmacy
Anticholinergic drugs
Precipitating factors
Respiratory failure
Shock
Sepsis
Metabolic disturbances
Prolonged venting
Prolonged sedatives
Pain
Immobility
Vision loss
Hearing loss
Disturbed sleep
Delirium mimics
Dementia
Depression
Psychosis
Functional imaging networks research
Default mode network
Salience network
Frontoparietal network
Default mode network
Reduced activity and connectivity
Self referential thought and consciousness
Salience network
Altered activation pattern
Regulation and attention and detecting important stimuli as
Frontoparietal network
Impairment in network connectivity
Higher cognitive function and executive function
Networks in psychosis
Default mode, salience and thalamocortical networks
Thalamocortical network in psychosis
Reduction in connectivity of the mediodorsal thalamus ( ínsula and orbito frontal cortex)
Neurotransmitters in delirium
Increased acetylcholine
Elevated dopamine
Reduced serotonin
Unclear roles of GABA and glutamate
Neurotransmitters in psychosis
Elevated dopamine
Glutamate NMDA hypofunction
Serotonin hyper function
Preventing delirium
Melatonin
Ear plugs and eye masks
Pain management
Constipation mx
