Delirium & Violence Risk

Question 1

Delirium - (pharm) Tx?

Answer 1

Antipsychotics
• Typical—haloperidol, atypical– quetiapine, olanzapine, and risperidone
• Low doses, short term use to minimize side effects

Benzodiazepines
• More sedating, may be helpful in very agitated patient
• Can increase confusion in elderly, respiratory depression an issue

Question 2

Delirium - 4 core features?

Answer 2

Disturbance of consciousness
Cognitive and perceptual disturbances
Sudden onset over hours to days
Direct physiological causes identified

Question 3

Delirium - key NT abnormalities?

Answer 3

↑ dopamine

↓acetylcholine

Question 4

Delirium - workup?

Answer 4

• Laboratory studies for metabolic derangement, drug toxicity, and to rule out sepsis
• CT head
• EEG
• Brain MRI in selected cases
• CSF in suspected CNS infection

Question 5

Most common cause of Delirium in elderly?

Answer 5

Polypharmacy

Question 6

Altered consciousness can result from a lesion or dysfunction of what parts of the CNS?

Answer 6

– Bilateral cerebral hemisphere
– Bilateral thalamus
– Brainstem

Question 7

Normal Consciousness depends on what 2 things?

Answer 7

– Intact cerebral hemispheres for cognition

– Reticular formation for alertness

Question 8

3 big high-risk meds that may cause Delirium?

Answer 8

– Anti-cholinergics-OTC
– Opioids
– Benzodiazepines
(though many others)