Delirium Flashcards
What is delirium?
- disturbance of consciousness and change in cognition that develops over a short period of time.
- change in mood and behaviour
what are the causes of delirium? (use VITAMIN CDE)
Vascular - stroke
Infection - UTI / Pneumonia, meningitis, encephalitis,
Trauma - concussion / head injury
Autoimmune - SLE
Metabolic - hypoxia, hypoN+, hypoCa2+, hepatic encephalopathy, renal / liver failure.
Iatrogenic - Drugs (toxic levels): - Anticholinergics - Anticonvulsants - Digoxin - L-dopa - Cortico-steroids - illicit drugs/steroids - Alcohol
Neoplastic
Congenital
deficiency:
- Thiamine deficiency
- Nicotinic deficiency
- B12 def
Drugs withdrawal:
- drug withdrawal e.g delirium tremens in alcohol withdrawal, benzodiazepines.
Endocrine:
- hypo/hyperthyroid
- hypopituitarism
- Cushing’s
- hyperparathyroidism
- hypoglycaemia
- Addison’s
OTHER:
- epilepsy (postictal)
- urine retention
- constipation
What are the risk factors for delirium?
- increasing age
- male
- cognitive impairment e.g. dementia
- long term illness
- pain
- immobile
- hypotensive
- polypharmacy
- depression
What are the symptoms of delirium?
- Fluctuating consciousness and attention
- diurnal variation ( worse at night)
- drowsy
- confusion
- disorientation
- disturbed sleep pattern
- incoherent speech
- poor memory / impaired recall
- episodic visual hallucinations
- Persecutory delusion
- uncooperative / restless
- feel frightened (emotional disturbance)
What is characteristic of hyperactive delirium?
- repetitive behaviour
- agitation
- delusions
What are the characteristics of hypoactive delirium?
- withdrawn
- quiet
(can be confused with depression)
What are the different types of delirium ?
hyperactive
hypoactive
mixed
How is the diagnosis of delirium made?
- History / exam
- collateral history
- AMTS
who is usually affected by delirium?
- children (as their brains are developing)
- elderly (especially those with dementia can have superimposed delirium)
Describe how to assess, manage and treat a patient with delirium
- AMTS
- find and treat underlying cause
- manage symptoms
- nurse in a well lit side room (to reduce confusion)
- may need to sedate with low dose of antipsychotic drugs e.g. haloperidol / droperidol (usually used de to lower anticholinergic effects)
Why is halopeidol / droperidol (antipsychotics) used to sedate delirium patients rather than antipsychotics such as chlorpromazine and thioridazine?
haloperidol and droperidol have less anticholinergic effects than chlorpromazine and thioridiazine. Anticholinergic drugs increase confusion in patients with delirium.
what are the differences between delirium and dementia? Consider the following aspects:
- onset
- DV
- duration
- consciousness
- attention
- orientated
- recall
- memory
- thinking
- delusions
- hallucinations / illusions
- sleep
Onset:
Delirium has an acute onset (hours / days)
Dementia has gradual onset (6 month)
Diurnal Variation:
Delirium = worse at night
Dementia = may be worse at night
Duration:
Delirium = days/weeks
Dementia = months / years
Consciousness:
Delirium = drowsy or hypervigilant
dementia = normal
Attention:
Delirium = poor
dementia = maintained
Orientation:
delirium = disorientated in time, place, person
dementia = similar
Instant recall :
delirium = impaired (not permenant)
dementia = impaired in later stages (permanent)
Memory :
delirium = impaired (but will recover)
dementia = permanent memory loss short term then long term.
thinking:
delirium = increased, reduces or muddled
dementia = reduced
Delusions:
delirium = common
dementia = occur, but less common
Hallucinations :
delirium = usually visual
dementia = in later stages
Sleep:
delirium = reversal of sleep-wake cycle
dementia = insomnia
