Delirium - psychiatric complications of physical disorders Flashcards
what is the most common mental health problem in hospitalised patients over 65 years old
delirium
5 key features of delirium
Impairment in consciousness Disturbance of cognition Psychomotor disturbances Disturbance of sleep wake cycle Emotional disturbance
define delirium
acute onset confusion with fluctuating course with impairment in cognition and altering consciousness
describe the continuum of impaired consciousness
clouding of consciousness
drowsiness
sopor
coma
describe disturbance of cognition
disorientation in time, place and person
impaired memory and attention
perceptual disturbance - hallucinations
what type of hallucinations do patients with delirium tend to get
visual
what are the divisions of psychomotor disturbance
hyperactive
mixed
hypoactive
describe hyperactive delirium
agitated
disoriented
aggressive + disruptive
describe hypoactive delirium
confusion
drowsy
sedation
quiet + withdrawn
describe disturbance in sleep wake cycle
insomnia sleep loss reversal of sleep cycle sundowning effect - worse at night nightmares
describe emotional disturbance
low mood
anxiety fear
irritability
causes of delirium mneumonic
infection withdrawal acute changes toxins/drugs hypoxia deficiencies endocrine acute vascular damage trauma heavy metals
causes of delirium
anticholinergics, anticonvulsants steroids opioids sedatives alcohol use and withdrawal BZD withdrawal hypoglycaemia epilepsy stroke, TIA, MI renal and hepatic failure
risk factors for delirium
age comorbidities post operative medications sensory deficits dementia previous delirium
investigations for delirium
History and examination FBC, U+E, LFT, TFT, glucose, CRP, Ca, B12, folate urinalysis 4AT, MoCA, CAM CXR CT/MRI brain
which cognitive assessment should not be used in delirium, what should be used instead
MMSE should not be used
use 4AT
management of delirium
Identify and treat cause
Manage environment and provide support
Prescribe - only sometimes
Review
how can you provide a supportive environment
well lit, quiet, calm room calendars and clocks sleep charts and hygiene fluid charts personal hygiene pain control
who do you prescribe for in delirium
those who are at harm to themselves or others
if environmental support has not worked
what is the 1st line medication
haloperidol
typical antipsychotic
in whom is haloperidol contraindicated and what is used instead
Parkinsons disease
alcohol withdrawal
lewy body dementia
neuroleptic sensitivity
chlordiazepoxide
why is it important to review and follow up delirium patients
review medications
check for dementia
what are people at risk of developing after having an episode of delirium
dementia
