Delirium (organic mental disorders)

Question 1

Who does delirium affect?

Answer 1

-Very common, especially in elderly in hospital
-30% prevalence in A+E patients

Question 2

What causes delirium?

Answer 2

-A clinical syndrome that involved abnormalities of thought, perception and levels of awareness
-Typically acute and is intermittent
-Can be hypo and hyperactive - symptoms often fluctuate
-Main causes (PINCH ME):
–Pain
–INfection
–Constipation
–Hydration
–Medications
–Environment
-Others = metabolic disorders, vit deficiencies, trauma, malignancy, urinary retention

Question 3

What risk factors are there for delirium?

Answer 3

-Increasing age
-Male
-Pre-existing cognitive deficit / previous episode of delirium
-Recent surgery
-Drug use / dependence
-Visual / hearing problems
-Social isolation
-Stress
-New environment

Question 4

How does delirium present?

Answer 4

NB good collateral history is key
-Usually acute / subacute presentation
-Fluctuating course
-Consciousness is clouded / impaired cognition / disorientation
-Abnormal perceptions
-Poor concentration
-Abnormal sleeping pattern
-Agitation / emotional lability
-Psychotic ideas

Question 5

What are the differential diagnoses for delirium?

Answer 5

-Dementia (esp LB)
-Depression
-Bipolar disorder
-Schizophrenia

Question 6

How would you investigate someone with delirium?

Answer 6

Aim is to find underlying cause:
-Full H+E
-Full bloods
-Urinalysis
-ECG
-Imaging if indicated

Question 7

What treatment would you consider in someone with delirium?

Answer 7

-Treat underlying cause
-Aim to treat in hospital
-4 categories:
–Supportive management
–Environmental management
–Medical management
–Post-discharge management