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3: Psych Y3 - Mental Health [10] > [8] Delirium > Flashcards

[8] Delirium Flashcards

1
Q

What is delirium?

A

Delirium is an acute, transient, global organic disorder of CNS functioning, resulting in impaired conciousness and attention

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2
Q

What are the different type of delirium?

A
  • Hypoactive
  • Hyperactive
  • Mixed
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3
Q

What causes delirium?

A

Delirium has a number of causes, however most cases are multifactorial

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4
Q

What are the categoies of causes of delirium?

A
  • Hypoxic
  • Endocrine
  • Infection
  • Stroke and other intracranial events
  • Nutritional
  • Post-operative
  • Metabolic
  • Abdominal
  • Alcohol
  • Drugs
  • Others
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5
Q

What are the hypoxic causes of delirium?

A
  • Respiratory failure
  • Myocardial infarction
  • Cardiac failure
  • Pulmonary embolism
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6
Q

What are the endocrine causes of delirium?

A
  • Hyperthyroidism
  • Hypothyroidism
  • Hyperglycaemia
  • Hypoglycaemia
  • Cushing’s
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7
Q

What are the infectious causes of delirium?

A
  • Pneumonia
  • UTI
  • Encephalitis
  • Meningitis
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8
Q

What are the intracranial causes of delirium?

A
  • Stroke
  • Raised ICP
  • Intracranial haemorrhage
  • Space-occupying lesions
  • Head trauma
  • Epilepsy
  • Intracranial infection
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9
Q

What are the nutritional causes of delirium?

A
  • Thiamine deficiency
  • Nicotinic acid deficiency
  • Vitamin B12 deficiency
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10
Q

What are the post-operative causes of delirium?

A
  • Anaesthetic
  • Opiate analgesics
  • Post-operative complications
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11
Q

What are the metabolic causes of delirium?

A
  • Electrolyte disturbance
  • Hepatic impairment
  • Renal impairment
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12
Q

What are the abdominal causes of delirium?

A
  • Faecal impaction
  • Malnutrition
  • Urinary retention
  • Bladder catheterisation
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13
Q

What are the alcohol-related causes of delirium?

A
  • Intoxication
  • Withdrawal
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14
Q

What drugs can cause delirium?

A
  • Benzodiazepines
  • Opiods
  • Anticholinergic
  • Anti-Parkinsonian medications
  • Steroids
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15
Q

What are the other causes of delirium?

A
  • Severe pain
  • Sensory deprivation, for example leaving the person with spectacles or hearing aids
  • Relocation
  • Sleep deprivation
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16
Q

What are the risk factors for delirium?

A
  • Hospital admission (delirium occurs in 15-20% of general admissions to hospital)
  • Older age (65 or over)
  • Multiple co-morbidities
  • Dementia (2/3 of cases occur in inpatients with pre-existing dementia)
  • Physical frailty
  • Renal impairment
  • Male sex
  • Sensory impairment
  • Previous episodes
  • Recent surgery
  • Severe illness
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17
Q

Describe the course of delirium?

A

Delirium has an acute onset, and takes a fluctating course, often worse at night

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18
Q

What are the symptoms of delirium?

A
  • Disorganised thinking, e.g. slowed, irrational, or incoherent thoughts
  • Euphoric, fearful, depressed, or angry
  • Language impaired, e.g. rambling speech, repetitive, disruptive
  • Illusions, delusions, and hallucinations
  • Reveral of sleep-wake pattern
  • Inattention
  • Unaware/disorientated
  • Memory deficits
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19
Q

What is the common form of delirium?

A

Hyperactive

20
Q

What is the problem with diagnosis of hyperactive delirium?

A

It often goes unrecognised, and can be confused with depression

21
Q

What are the symptoms of hypoactive delirium?

A
  • Lethargy
  • Decreased motor activity
  • Apathy
  • Sleepiness
22
Q

What are the symptoms of hyperactive delirium?

A
  • Agitation
  • Irritability
  • Restlessness
  • Aggression
  • Hallucinations and delusions may be present
23
Q

What might hyperactive delirium be confused with?

A

Functional psychoses

24
Q

What is the ICD-10 criteria for delirium?

A
  • Impairment of consciousness and attention
  • Global disturbance in cognition
  • Psychomotor disturbance
  • Disturbance of sleep-wake cycle
  • Emotional disturbances
25
Q

What is the difference between delirium and dementia in terms of the sleep-wake cycle?

A

It is disrupted in delirium, and usually normal in dementia

26
Q

What is the difference between delirium and dementia in terms of attention?

A

In delirium, it is markedly reduced. In dementia, is is normal or reduced

27
Q

What is the difference between delirium and dementia in terms of arousal?

A

It is increased or decreased in delirium, but usually normal in dementia

28
Q

What is the difference between delirium and dementia in terms of autonomic features

A

They are abnormal in delirium, normal in dementia

29
Q

What is the difference between delirium and dementia in terms of duration?

A

Hours to weeks in delirium, months to years in dementia

30
Q

What is the difference between delirium and dementia in terms of delusions?

A

Fleeting in delirium, complex in dementia

31
Q

What is the difference between delirium and dementia in terms of the course?

A

It is fluctating in delirium, stable/slowly progressive in dementia

32
Q

What is the difference between delirium and dementia in terms of the conscious level?

A

It is impaired in delirium, no impairment in dementia

33
Q

What is the difference between delirium and dementia in terms of hallucinations?

A

They are common in delirium, and usually visual. They are uncommon in dementia

34
Q

What is the difference between delirium and dementia in terms of onset?

A

Acute/subacute in delirium, chronic in dementia

35
Q

What is the difference between delirium and dementia in terms of psychomotor activity?

A

Usually abnormal in delirium, usually normal in dementia

36
Q

How is delirium investigated?

A
  • Thorough physical investigation
  • History
  • MSE
  • Routine investigations
  • Investigations based on history/examination
  • Diagnostic questionnaire
37
Q

What is included in the physical exmaination in delirium?

A
  • ABC assessment
  • Conscious assessment (AVPU or GCS)
  • Vital signs, including oxygen saturations, pulse, blood pressure, temperature, and capillary blood glucose
  • Nutritional and hydration status
  • Cardiovascular examination
  • Respiratory examination
  • Abdominal examination
  • Neurological examination
38
Q

What routine investigations are done in delirium?

A
  • Urinalysis
  • Bloods – FBC, U&Es, glucose, CRP, TFTs, B12, folate, ferritin
  • ECG – looking for cardiac abnormalities or ACS
  • CXR – looking for chest infection
  • Infection screen
  • Blood culture – sepsis
  • Urine culture – UTI
39
Q

What investigations might be done in delirium, based on history/examination?

A
  • ABG if suspect hypoxia
  • CT head if suspect head injury, intracranial bleed, CVA
  • Lumbar puncture if suspect meningitis
  • EEG if suspect epilepsy
40
Q

How are diagnostic questionnaires useful in delirium?

A

They can help with diagnosis and monitoring

41
Q

What diagnostic questionnaires can be used in delirium?

A
  • Abbreviated mental state test (AMT)
  • Confusion assessment method (CAM)
  • MMSE
42
Q

What are the differential diagnoses of delirium?

A
  • Dementia
  • Mood disorders – depression or mania
  • Late onset schizophrenia
  • Dissociative disorders
  • Hypothyroidism and hyperthyroidism
43
Q

How is delirium managed?

A
  • Treat underlying cause
  • Reassurance and re-orientation – reassurance will reduce anxiety and disorientation, and patient should be reminded of the time, place, day, and date regularly to re-orientate
  • Provide appropriate environment
  • Managing disturbed, violent, or distressed behaviour
44
Q

What are the features of an appropriate environment in delirium?

A
  • Quiet, well-lit side room
  • Consistency in care and staff
  • Reassuring nursing staff
  • Encourage presence of friend or family member
  • Optimise sensory acuity
45
Q

How should disturbed, violent, or distressed behaviour in delirium managed?

A
  • Encourage oral intake and pay attention to continence
  • Verbal and non-verbal de-escalation techniques
  • Oral low-dose haloperidol (0.5-4mg) or olanzapine (2.5-10mg)
  • Avoid benzodiazepines, unless delirium is due to alcohol withdrawal

3: Psych Y3 - Mental Health [10] (21 decks)

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