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Clinical presentation of delirium?

disturbance of consciousness with reduced ability to focus or hold attention.
change in cognition or development of a perceptual disturbance (hallucinations, may be frightening)
occurs over short period of time, FLUCTUATES


Risk factors of delirium?

age, pre-existing dementia, medical comorbidity, history of brain injury, history of alcohol abuse, male, sensory impairment, malnourishment, dehydration


what is the Confusion Assessment Method? what does it ask?

1. acute onset and fluctuating course?
2. inattention
3. disorganized thinking
4. altered LOC
(must have 1 and 2, plus either 3 or 4)


behavioral treatment of delirium?

use of orienting devices (clocks, calendars, TV)
regular sleep-wake cycle
use of glasses, hearing aids
mobilize patient as soon as possible (gets foley out)
adequate nutrition


pharm treatment for agitation related to delirium?

-haloperidol. has minimal side effect profile compared to antipsychotics.
-atypical antipsychotics (risperidone, olanzapine, Quetapine)
-non-benzo anxiolytics (trazodone, gabapentin), if want to avoid antipsychotics


what symptoms can we see in a state of delirium?

disorientation (common, not required), sleepiness, losing train of thought, hearing things, agitation
may be paranoid delusions
activity level may be increased OR decreased


if we witness someone with visual hallucinations, what kind of disease state should we think of?

medical/neuro problem.
we rarely see visual hallucinations in psych conditions: more AUDITORY hallucinations


signs of hyperactive delirium?

agitation, hyper-arousal, hallucinations, deulsions, can be mistaken for primary psych disorder
may respond to dopamine-blocking agents (haloperidol)


signs of hypoactive delirium?

may be mistaken for depresssion, lethargy, confusion, sedation


the cardinal symptom of delirium is ?

new onset of fluctuation in mental status


T/F: if an extensive medical workup has shown no abnormalities, the diatnosis of a patient with acute mental status change is not likely to be delirium

delirium is a global brain dysfunction based on an underlying condition, whether or not we can find it


generally, what is the treatment strategy for delirium?

treat the underlying medical condition that is causing it.


which neurotransmitters are thought to be involved in the pathophysiology of delirium?

too little dopamine, too much acetylcholine


if you see a focal problem on EEG, is this likely to be delirium?

NO, delirium is generalized.


what classes of meds can cause delirium? (4)

-anticholinergics (delirium is a problem with too much acetylcholine, and these increase acetylcholine)


what is the best screening tool for delirium?

Confusion Assessment Method


can the MoCA be useful for delirium?

only if you have a history/baseline


would I use benzos to treat delirium?

NO, unless cause of delirium is alcohol of benzo withdrawal.
there is a potential for paradoxical effect.


why do we even treat delirium?

agitation, paranoia