Delirium - psychiatric complications of physical disorders

Question 1

what is the most common mental health problem in hospitalised patients over 65 years old

Answer 1

delirium

Question 2

5 key features of delirium

Answer 2

Impairment in consciousness
Disturbance of cognition 
Psychomotor disturbances 
Disturbance of sleep wake cycle
Emotional disturbance

Question 3

define delirium

Answer 3

acute onset confusion with fluctuating course with impairment in cognition and altering consciousness

Question 4

describe the continuum of impaired consciousness

Answer 4

clouding of consciousness
drowsiness
sopor
coma

Question 5

describe disturbance of cognition

Answer 5

disorientation in time, place and person
impaired memory and attention
perceptual disturbance - hallucinations

Question 6

what type of hallucinations do patients with delirium tend to get

Answer 6

visual

Question 7

what are the divisions of psychomotor disturbance

Answer 7

hyperactive
mixed
hypoactive

Question 8

describe hyperactive delirium

Answer 8

agitated
disoriented
aggressive + disruptive

Question 9

describe hypoactive delirium

Answer 9

confusion
drowsy
sedation
quiet + withdrawn

Question 10

describe disturbance in sleep wake cycle

Answer 10

insomnia
sleep loss 
reversal of sleep cycle 
sundowning effect - worse at night 
nightmares

Question 11

describe emotional disturbance

Answer 11

low mood
anxiety fear
irritability

Question 12

causes of delirium mneumonic

Answer 12

infection 
withdrawal 
acute changes 
toxins/drugs 
hypoxia 
deficiencies
endocrine 
acute vascular damage 
trauma 
heavy metals

Question 13

causes of delirium

Answer 13

anticholinergics, anticonvulsants
steroids
opioids
sedatives
alcohol use and withdrawal 
BZD withdrawal
hypoglycaemia
epilepsy 
stroke, TIA, MI
renal and hepatic failure

Question 14

risk factors for delirium

Answer 14

age
comorbidities
post operative
medications 
sensory deficits
dementia 
previous delirium

Question 15

investigations for delirium

Answer 15

History and examination 
FBC, U+E, LFT, TFT, glucose, CRP, Ca, B12, folate
urinalysis 
4AT, MoCA, CAM
CXR
CT/MRI brain

Question 16

which cognitive assessment should not be used in delirium, what should be used instead

Answer 16

MMSE should not be used

use 4AT

Question 17

management of delirium

Answer 17

Identify and treat cause
Manage environment and provide support
Prescribe - only sometimes
Review

Question 18

how can you provide a supportive environment

Answer 18

well lit, quiet, calm room 
calendars and clocks
sleep charts and hygiene 
fluid charts
personal hygiene 
pain control

Question 19

who do you prescribe for in delirium

Answer 19

those who are at harm to themselves or others

if environmental support has not worked

Question 20

what is the 1st line medication

Answer 20

haloperidol

typical antipsychotic

Question 21

in whom is haloperidol contraindicated and what is used instead

Answer 21

Parkinsons disease
alcohol withdrawal
lewy body dementia
neuroleptic sensitivity

chlordiazepoxide

Question 22

why is it important to review and follow up delirium patients

Answer 22

review medications

check for dementia

Question 23

what are people at risk of developing after having an episode of delirium

Answer 23

dementia