What are the CAM criteria for delirium?
2. Disordered thinking AND/OR Change in conscious level
3. Acute onset and fluctuating course
What sorts of cognitive disturbances may delirious patients experience?
Impaired memory and attention
Perceptual changes (hallucinations)
Disorientation (time, space, person)
What are the two terms used to describe a patient's psychomotor state?
OR it could be a mixed picture
What is psychomotor retardation often misdiagnosed as?
What sort of hallucinations are seen in organic problems?
What sort of hallucinations are seen in primary psychiatric illness?
What is "sundowning" in the context of delirium?
Tendency for symptoms to worsen at night
So patients spend the day asleep and are awake (and often agitated) at night
Which mood disorder is often misdiagnosed in delirious patients?
due to psychomotor retardation, sedation, apathy
Do you need to have an identified cause of delirium to be officially diagnosed?
Underlying cause may have gradual onset or be in subclinical phase
Delirium is a clinical diagnosis
What is the usual
a) Acute onset
b) Fluctuating course
c) Weeks to months
What are the causes of delirium?
Virtually any disease
Which group of patients is more susceptible to delirium?
Frail patients with co-morbidities
which tends to be the elderly
Apart from diseases, what can cause delirium?
Which therapeutic drugs can precipitate delirium?
Drugs used for PD - levodopa, dopamine agonists
Which recreational drugs can precipitate delirium?
Use of drugs can cause delirium.
What else can precipitate it?
Withdrawal from drugs
alcohol, opiates, benzos
Any significant ___ to the body can precipiate delirium.
How is delirium diagnosed?
based off CAM criteria
What age of patient is predisposed to developing delirium?
Frail, more likely to have existing comorbidities
A past psychiatric history of which illnesses predisposes a patient to delirium?
Sensory ___ (e.g hyper/hypothermia) and ___ (e.g deafness, blindness) can precipitate delirium.
Sensory extremes and deficits
After which intervention are patients particularly vulnerable to delirium?
Perioperative period where patient is recovering
Exposing a frail elderly patient to a new ___ may precipitate delirium.
Apart from history and examination, how would you assess a patient's cognitive function?
Formal cognitive testing
so 4AT, MOCA, ACE-III
How can the environment of a patient with delirium be improved to prevent unneccessary distress?
Well lit, quiet
Orienting factors (e.g a clock, 24H news)
Minimise staff changes
Remove unneccessary equipment
Which renal investigation should be done in patients with delirium?
to exclude UTI
Which blood tests should you request for a delirious patient?
FBC, WCC and inflammatory markers
LFTs and TFTs
Vit B12 and folate
Why must you do a urinalysis for a delirious elderly patient?
UTI is a common cause of delirium in the elderly
What is the standard pharmacological management for delirium?
Antipsychotics e.g haloperidol
Which class of drug is only used if necessary in agitated delirium patients?
Sedation lasts for a while, tends to worsen delirium