Delirum

Question 1

What is delirium?

Answer 1

Disturbance in attention
Change in cognition
Develops acutely
Tends to fluctuate 
Organic cause rather than mental health issue

Question 2

What is the pathophysiology of delirium?

Answer 2

Changes in neurotransmitters (especially ACh)
Toxic insults to brain - drugs, hypoxia, low sodium/ glucose
Stress hormones - cortisol, prostaglandins, cytokines,

Question 3

What are predisposing factors to delirium? (10)

Answer 3

Advanced age
Pre-existing dementia
Co-morbid
Post-op
Terminally ill
Sensory deficit
Polypharmacy
Depression
Alcohol dependent
Malnutrition

Question 4

What are the subtypes of delirium?

Answer 4

Hyperactive

Hypoactive

Question 5

Which subtype of delirium has the higher mortality?

Answer 5

Hypoactive - more easily missed

Question 6

What does the 4AT tool cover?

Answer 6

Alertness
AMT4 - age, DOB, place, current year
Attention - months of year backwards
Acute change or fluctuating course

Question 7

What does the Confusion Assessment Method (CAM) cover?

Answer 7

Acute onset and fluctuating course
Inattention
Disorganised thinking
Altered level of consciousness

Question 8

What medication can be given in delirium?

Answer 8

Haloperidol - oral start low dose, max 5mg in 24 hours
Quetiapine - 25 mg oral for patients with parkinsons/ lewy body dementia
Benzodiazepines - use only if alcohol or benzo withdrawal or if seizure (lorazepam)