SM_86b: Delirium

Question 1

Describe DSM V criteria for delirium

Answer 1

DSM V criteria for delirium

• Disturbance in attention and awareness
• Disturbance develops over a short period of time, represents change from baseline attention and awareness, and tends to fluctuate in severity during the course of the day
• An additional disturbance is cognition
• Disturbance is caused by direct physiological consequences of another general medical condition, substance intoxication / withdrawal, exposure to toxin, or multiple etiologies

Question 2

Delirium is associated with ____ and ____

Answer 2

Delirium is associated with sleep-wake cycle disruption and emotional regulation

Question 3

Clinical domains of delirium are ____, ____, ____, ____, and ____

Answer 3

Clinical domains of delirium are impairment of consciousness / attention, disturbance of congition, psychomotor disturbance, circadian rhythms, and emotional dysregulation

Question 4

Delirium is associated with ____

Answer 4

Delirium is associated with dementia

Question 5

Predisposing factors for delirium are ____, ____, and ____

Answer 5

Predisposing factors for delirium are age, cognition (dementias, TBI, cognitive impairments), and frailty

Question 6

____ is a risk factor for delirium, particularly with anticholinergics, benzodiazepines, opioids, and corticosteroids

Answer 6

Polypharmacy is a risk factor for delirium, particularly with anticholinergics, benzodiazepines, opioids, and corticosteroids

Question 7

Delirium workup includes ____, ____, and ____

Answer 7

Delirium workup includes cognitive testing, labs, and imaging

Question 8

Describe components of cognitive testing for delirium

Answer 8

Components of cognitive testing for delirium

• Attention
• Memory
• Semantics
• Visuospatial
• Abstraction
• Reasoning
• Calculation
• Language
• Naming
• Reading
• Writing
• Planning
• Inhibition

Question 9

Dementia with Lewy bodies core features include ____, ____, and ____

Answer 9

Dementia with Lewy bodies core features include fluctuating cognition with variations in attention and alertness, recurrent visual hallucinations, and parkinsonism

Question 10

Describe differential diagnosis of delirium

Answer 10

Differential diagnosis of delirium

Question 11

Describe common labs/investigations for delirium

Answer 11

Common labs/investigations for delirium

• Vital signs
• CBC
• Chemistry-12
• Mg, P
• Urinalysis
• Urine drug screen

Question 12

EEG is useful in differentiating delirium from ____

Answer 12

EEG is useful in differentiating delirium from other neurological and psychiatric conditions

Question 13

In delirium workup, head CT / brain MRI may ____, while EKG is checked for ____

Answer 13

In delirium workup, head CT / brain MRI may demonstrate cerebrovascular disease and EKG is checked for medication monitoring

Question 14

First line treatment for delirium ____

Answer 14

First line treatment for delirium always must address the underlying cause

Question 15

Describe the ABCDEF bundle

Answer 15

ABCDEF bundle

• Assess / treat pain
  Awakening trials
• Breathing trials
• Coordination of care
• Choice of sedatives
• Delirium reduction: diseases, drug removel, environment
• Early monitoring and exercise
• Family: communication and involvement

Question 16

____ is an antipsychotic that may be helpful in delirium treatment, while ____ may also be effective

Answer 16

Haloperidol is an antipsychotic that may be helpful in delirium treatment, while a2 agonists may also be effective