What is delirium?
A state of
disordered thinking (orientation, memory, concentration, changes in perception)
which comes on acutely and fluctuates in severity
What are the four CAM criteria for diagnosing delirium?
Acute onset, fluctuating course
Disordered thinking OR Change in conscious level
What two words can be used to describe the conscious level of delirious patients?
Hyperaware (on edge, may jump at small noises)
Hypoaware (drowsy, unresponsive)
16-24% of patients develop ___ during hospital stays.
Delirium is typically better during the ___ and worse during the ___.
(day / night)
better during the day (so the patient may sleep)
worse at night (so they patient is kept up)
so sometimes their sleep cycle reverses
What are some predisposing factors (not causes) of delirium?
Brain injury (trauma, alcohol abuse, stroke, dementia)
Sudden change in environment
What are some causes of delirium?
Acute illness (infection, trauma, post-op)
Polypharmacy (being on loads of drugs)
What drugs can exacerbate delirium?
Opiates (codeine, morphine etc.)
Antidepressants (SSRIs like citalopram, tricyclic antidepressants like amitriptyline)
Antimuscarinics (think incontinence drugs like tolterodine)
Dopamine agonists (think cabergoline for prolactinomas)
What tools are used to diagnose delirium?
Patients often have (one / more than one) cause for their delirium.
more than one cause
How is delirium managed?
Treat underlying cause
Make sure environment is comfortable for the patient
Which drugs can be used as a last resort to sedate a delirious patient?
Haloperidol (not in patients with Parkinson's disease)
Quetiapine (Parkinson's, dementia with hallucinations)
Benzodiazepine (like lorazepam, very rarely)
How long does it take a patient to recover from delirium?
(weeks - months)