Psych - Delirium Flashcards
What is Delirium?
Acute Brain Failure
Reversible global impairment of cognitive processes
transient, reversible dysfunciton in cerebral metabolism that has an acute or sub-acute onset and is manifest cliically by a wide array of neuropsychiatric abnormalities
Criteria for Delirium?
- Disturbance in attention and awareness that develops over a short period of time
- Represents a change from baseline attention and awareness
- tends to fluctuate in severity
Can have additional cognitive disurbances
-Not explained by another preexisting NCD
-Due to substance or to an underlying medical condition
What are the cliical features of deliirium?
- Has a Prodrome that is non-specific*
- Then*
Attentional Deficit - disorganized thinking, rambling, short term memory impairment, etc
Changes in Cognition (memory, orientation, language etc)
Perceptual disturbances
Changes in psychomotor behavior
Abnormal though processes and Labile emotions
Sleep-Wake Cycle Disturbanes
FLUCTUATIONS IN SYMPTOMS!!!!
What is difference on EEG in delirium vs NCD?
Delirium typically shows diffuse slowing on EEG more commonly than dementia
What populations of patients are most at risk for delirium?
Post-Cardiac patients
Burn Patients - get burn encephalopathy from breakdown products from skin
Elderly to the ER
Terminally ill cancer patients before death
Stem cell transplant patients
ICU patients
Nursing home patients over age 65
Predisposing factors for delirium?
AGE - very old and very young
ANY****Pre-existing brain damage or cognitive defects along with drug additiction or sensory deficits
Elevated BUN - Uremia increases BBB permeability
Low Serum Albumin
Medication Exposure
What does the EEG show in delirium?
Diffuse slowing of dominant alpha waves with the appearance of abnormal slow waves (theta and delta waves)
[*exception - sedative withdrawal delirium]
What is the pathophysiology of delirium?
Impairment of general attentional mechanisms via the reticuar activating system and its diffuse interaction with the cortex
Reduction in Cholinergic pathway as well
What is Wernicke’s Encephalopathy and how does it present?
Delerium from Thiamine Deficiency (typically seen in alcoholics)
TRIAD: Delerium, ATaxia, and inability to look laterally
Poisoning with what common calssification of drug agents can cause delirium?
Anticholinergics!!! Such as Scopolamine or tricyclic andidepressants, antihistamines etc
Bind as a bat, hot as a hare, red as a beet, drug as a bone, mad as a hatter
big pupils and confusion
What analgesic is particularly prone to causing delirium?
MEPERIDINE!!!!!! it’s metabolite, Normeperidine, causes delirium
Salicylates and anti-inflammatories can also cause it
What are some non-specific treatment options while managing the underlying cuase for delirium?
Medical - take frequent vitals, serial physical and mental status exams, fluid and nutrition, stop non-essential meds, pain
Psychosocial - increased ambulation
Environmental - familiar objects, reoritentation, frequent toileting
What are pharmacologic agents you can give in delirium?
Anti-psychotics - Haloperidol –> good for treating delusions and hallucinations or calming agitation
DO NOT GIVE ANTI-CHOLINERGICS OR HYPOTENTIVE DRUGS
Benzos –> Used for withdrawal delirium only!!
What are the better anesthetics to use in heart surgery to prophyslactically prevent delirium?
Dexmedetomidine - Alpha 2 adrenergic receptor agonist is better than midazolam or propofol
What is the main treatment for delirium?
TREAT THE UNDERLYING CAUSE!
