The Most Basic Delirium Recap Ever Flashcards
what are the three subtypes of delirium?
hyperactive, hypoactive, mixed
mixed MC
what percentage of patients with baseline dementia experience delirium in the hospital?
65 percent
what percentage of geriatric patients will have an episode of delirium prior to death?
83 percent
what is the one year mortality rate of an episode of delirium?
35-40 percent
is delirium associated with underlying dementia?
YES; strongly
what brain structure is thought to contribute to hyperarousal and sensory overload in patients with delirium?
thalamus
delirium is thought to be a disruption in neurotransmitters. do we have a deficiency or increase in cholinergic activity? how about dopamine?
cholinergic deficiency (hence why anticholinergics make delirium worse)
excess dopamine (hence why antipsychotics help)
what percentage of delirious patients are demented?
25 percent
_____ can lead to increased pain perception, diminished concentration, increased sympathetic tone
sleep deprivation
what is the most prevalent predisposing factor for delirium? how about the most important precipitating factor?
MC predisposing = 3+ comorbid conditions
MC precipitating: 3+ new drugs (polypharmacy)
cognitive impairment at baseline, restraints, and sensory deprivation (vision) are the three risk factors for what?
prolonged delirium
hyperactived/mixed delirium is often due to which events?
1) cholinergic toxicity
2) serotonin syndrome
3) stimulant toxicity
4) ETOH/benzo withdrawal
hypoactive delirium is often due to which types of drugs and things?
benzos
narcotic overdose
sedatives/hypnotics/ETOH
are atypical antipsychotics (seroquel) better than typical antipsychotics (haldol) in delirium?
NOooo
haldol and risperidone best
what is the CAM? what does it entail?
confusion assessment model
1) acute change and fluctuation in mental status and behavior AND
2) inattention AND EITHER
3) disorganized thinking OR
4) altered consciousness (hypervigilant vs. hypoarousal, etc)
is the CAM alone enough to DX delirium?
no, do after MMSE
also do with tests of attention
picture recall, spelling “world” backwards, days of week/months backwards are examples of what?
tests of attention
characterized by a rapid onset, a defect in attention, fluctuating during the course of a day
delirium
are visual hallucinations common in delirium?
yes
characterized by an insidious onset, primarily a defect in short term memory, with often NORMAL attention that does NOT fluctuate during the day
dementia
which group is able to attend to a MMSE and clock draw, delirium or dementia?
dementia!
they can attend to it, but cannot perform it well
delirium can’t attend to it
what are the two hallmarks of lewy-body dementia? how do we treat?
fluctuating changes (less abrupt than delirium) and well formed visual hallucinations
treat with seroquel
what is the mnemonic for causes of delirum?
DELIRIUMS + P
1) Drugs, toxins
2) Eyes, ears (sensory deprivation)
3) Low O2 sats (MI, ARDS, PE, COPD, shock, stroke)
4) Infection
5) retention of urine/stool, restraints
6) Ictal (post) serizure
7) Underhydration, undernutrition
8) Metabolic (hypo/hyperglycemia, calcemia, uremia, liver failure, thyroid disorders)
9) Sleep deprivation, oversedation, stroke
10) P for pain
a study was performed on different interventions to reduce delirium. which two interventions were proven to lower risk of delirium the most?
cognition (orientation, activities) and sleep deprivation!
are there any drugs labeled for delirium on the market?
NO, all off label
by what percentage may we reduce delirium events if we consider early intervention protocol?
40 percent
things like hearing aids, visual aids, ambulation, exercise, bedtime routines, activities, volume replacement if dehydrated
why do we worry about prescribing neuroleptics in people with delirium?
black box warning for death in people with dementia!
should we give benzos to calm down our agitated delirious patient?
NO
we should avoid typical antipsychotics in ______
parkinsons and lewy body dementia
