Neurocognitive Dxs - Delirium

Question 1

DSM- 5 Diagnostic Criteria

A. Delirium is a disturbance in _____ & _____

Answer 1

Attention (reduced ability to direct, focus, sustain, and shift attention) & awareness (reduced orientation to the environment)
- Floats in and out of contact with environment

Question 2

DSM- 5 Diagnostic Criteria
B. Delirium develops over a 1._____ period of time, represents a 2.______ _____ ______ attention and awareness, and tends to 3. ______ in severity over the 4._____ ___ _ _____.

Answer 2

1. short (usually hours to a few days)
2. change from baseline
3. fluctuate
4. course of a day (characteristic 24 hour variation; can have lucid periods; usually worse at night)

Question 3

DSM- 5 Diagnostic Criteria
C. Delirium has an additional disturbance ___ ______ (memory deficit, disorientation, language visuospatial ability, or perception).

Answer 3

disturbance in cognition

• memory deficits - most often for recent memory
• If there are hallucinations, they tend to be visual
• fleeting paranoid delusions in 40-70% of delirious adults

Question 4

DSM- 5 Diagnostic Criteria

D. Disturbances in delirium cannot be better explained by…

Answer 4

1. Another pre-existing, established, or evolving neurocognitive Dx (dementia)
   AND
2. Are not occurring in the context of a severely reduced level of arousal, such as a coma

Question 5

DSM- 5 Diagnostic Criteria
E. Evidence from Hx, physical examination, or lab findings that delirium disturbance is a…
1. Direct physiological consequence of _______
2. ________ intoxication, or withdrawal
3. Exposure to a ______, OR
4. Due to multiple ________

Answer 5

1. another medical condition
2. substance
3. toxin
4. etiologies

Question 6

DSM- 5 Delirium Specifiers
Hypoactive delirium means...
1.  \_\_\_\_\_\_\_
2.  \_\_\_\_\_\_\_
Hypoactive is....
3. \_\_\_\_\_ of all delirium cases 
4. has a \_\_\_\_\_\_ prognosis
5. more likely to be \_\_\_\_\_\_ in diagnosis
6. Mistakenly diagnosed as \_\_\_\_\_\_ sometimes

Answer 6

1. Lethargy approaching stupor
2. Slow to respond to questions
3. half
4. poorer
5. missed
6. dementia

Question 7

DSM- 5 Delirium Specifiers
Hyperactive delirium means...
1. increased \_\_\_\_\_\_\_\_
2. poor \_\_\_\_\_\_\_\_
3. mood \_\_\_\_\_\_\_\_
4. agitation, \_\_\_\_\_\_\_\_
5. refuse \_\_\_\_\_\_\_\_

Answer 7

1. increased psychomotor activity
2. poor judgment
3. mood lability
4. agitation, specifically at night
5. refuse to cooperate with medical care

Question 8

DSM- 5 Delirium Specifiers
Mixed delirium means
1. Mixed presentation of either/or \_\_\_\_\_ and  \_\_\_\_
2. activity levels \_\_\_\_\_\_\_, OR
3. Normal level of  \_\_\_\_\_\_\_\_\_

Answer 8

1. hyper and hypo
2. activity levels rapidly fluctuate, OR
3. normal level of psychomotor activity despite attention and awareness disturbance

Question 9

DSM- 5 Delirium Associated Features

1. Sleep/wake cycle is _______
2. Physiological symptoms include _____, _____, ______
3. Impaired _______

Answer 9

1. disturbed, daytime sleepiness and nighttime agitation
2. physical symptoms include fever, elevated heart rate, incontinence.
3. impaired judgment

Question 10

DSM- 5 Delirium Basic Info

1. _____ patients remember experience
2. Older adults with delirium are 3-5x more likely to __________

Answer 10

1. One-third

2. develop dementia

Question 11

Delirium - Vulnerable Groups

1. Children
   1a. _____ fevers
   1b. Differs from emergence delirium in that it is _____; ______; and children are ____ > more likely than adults
2. Hos _____(27%)
3. ____ adults coming to____
4. ____, hospitalized _____ with COVID

Answer 11

1a. high fevers
1b. brief - 20-30 mins; post-op; 3x>likely than adult
2. Hospice (27%)
3. Older adults coming to ER
4. Older, hospitalized adults with COVID (presence increases odds of dying from COVID)

Question 12

Delirium Treatment - Psychological
Preventative = HELP programs contain components like:
1. Clear ________
2. Appropriate levels of sensory _________
3. Reminders to _______ orientation
4. Consistent _____
5. Surround with familiar _______
6. Sleep _____, nutrition, and ______
7. ______ engagement with ______ volunteers
8. Psycho______.
9. Music _______
10. Medication review/_______ of _______ meds

Answer 12

1. communication
2. sensory stimulation
3. increase orientation (clock, calendar, daily schedules)
4. staffing
5. familiar objects
6. hygiene, nutrition, and hydration
7. Social engagement with trained volunteers
8. psychoeducation
9. music therapy
10. medication review/elimination of unnecessary meds

Question 13

Delirium Treatment - Pharmacotherapy

1. There is no _____ pharmacotherapy tx
2. Antipsychotics used to ______ agitation but evidence suggests they _______ duration of delirium
3. Avoid benzo_______ except in alcohol ______ delirium
4. ________ helps but use is restricted to inpatient because it _____ heart rate and _____ blood pressure

Answer 13

1. supported
2. decrease agitation, increases duration
3. benzodiazepines, except in alcohol withdrawal delirium
4. Dexmedetomidine; slows heart rate and drops blood pressure