Delirium Flashcards
What are 4 aspects of the DSM-IV diagnostic criteria of delirium?
Disturbance of consciousness; change in cognition not accounted for by dementia; hours/days to develop and fluctuate during day; disturbance caused by consequences of a medical condition.
What are some common symptoms of delirium?
Fluctuating inattention, disorganised thinking, impaired cognition, altered consciousness, altered sleep-wake cycle, emotional disturbace.
What are 4 psychomotor variants of delirium? How common is each? Which form is under/misdiagnosed?
25% hyperactive, 25% hypoactive (under/misdiagnosed), 35% mixed with flux and lucid intervals, 15% normal.
List 6 predisposing factors of delirium.
Age, impaired cognition, history of delirium, depression, visual/hearing impairment, dehydration, malnutrition, drugs, chronic disease.
List 4 precipitating factors of delirium.
Drugs, neurological disease, intercurrent illness, surgery, sleep deprivation, poor environmental factors (eg. catheter, poor lighting, immobility)
What is the relative prevalence of delirium in patients in a medical ward, in ICU and palliative care? Why is it important to recognise?
Medical: 5-80%; ICU: 7-83%; pall care: 45%.
Increases mortality, hospital stay, complications (falls/incontinence/pressure sores).
What are the 4 components of the Confusion Assessment Method (CAM) and what other test must be done to validate the results? What are the results for delirium?
1 Acute onset + fluctuating course; 2 inattention; 3 disorganised thinking; 4 altered level of consciousness. Need cognitive assessment too. Delirium: (1+2) + 3 or 4
What are 2 key distinguishing features between dementia and delirium? Which form of dementia is most easily confused with delirium?
Timing: dementia develops over months/years (vs hours/days) and won’t fluctuate over hours.
Impaired attention is a key feature of delirium, mostly intact in dementia.
Dementia with Lewy bodies - visual hallucinations and fluctuations possible.
What are recommended 1st line investigations when suspecting delirium? What other tests may be considered?
FBE, CRP & ESR, Urea & electrolytes, glucose, LFTs, CMP.
Consider: MSU, CXR, blood cultures. CT brain, TFTs, drug levels.
What are 3 supportive measures in managing delirium?
Protect airway, maintain hydration and nutrition, position and mobilise.
What is involved in the non-pharmacological management of delirium? What are 2 things to avoid?
Create a calm & comfortable environment & involve relatives if possible. Orientate with calendars/clocks. Minimise staff changes. Avoid sleep deprivation, exercise in day. Avoid restraint and immobilising devices.
When is pharmacotherapy indicated in managing delirium?
If safety of patient or others threatened; delirium preventing essential therapy/care for other condition.
What drugs are most used in managing delirium? What are they used for?
Haloperidol, respirdone. Only for agitation/hallucination. Not hypo symptoms. Not with Parksinons or lewy body dementia.
Benzos only if anxiety or withdrawal and best avoided.
How long does it take for delirium to resolve if treated? What are some possible complications? What are 3 things to consider before/at discharge?
Usually resolve in days to week. May suggest dementia, cognition may be impaired. Risk of decline. Educate family/carers; assess meds; assess driving ability.
