Confusion Flashcards
(21 cards)
What is the difference between delirium and dementia?
Delirium has an acute onset, fluctuating course, and impaired attention/consciousness. Dementia is chronic, progressive, and attention is usually preserved until late stages.
What are common causes of acute confusion in hospitalized patients?
Infections (e.g. UTI, pneumonia), metabolic disturbances (e.g. hypoglycemia, hyponatremia), medications, alcohol withdrawal, stroke, and pain.
What is the Confusion Assessment Method (CAM) used for?
To diagnose delirium. It includes: acute onset and fluctuating course, inattention, disorganized thinking, and altered level of consciousness.
What is the importance of checking for urinary retention or constipation in a confused elderly patient?
Both are common, reversible causes of delirium in the elderly and should be addressed promptly.
What is Wernicke’s encephalopathy and how does it present?
Thiamine deficiency (commonly in alcoholics); triad of confusion, ataxia, and ophthalmoplegia.
How can you differentiate hypoactive delirium from depression in elderly patients?
Hypoactive delirium has fluctuating alertness, inattention, and acute onset, while depression has persistent low mood, preserved attention, and longer duration.
What investigations are essential in a patient presenting with confusion?
Full blood count, U&Es, glucose, LFTs, CRP, calcium, TSH, B12, CT head (if focal signs or trauma), and urinalysis.
What is hepatic encephalopathy and how does it present?
Confusion due to liver failure and ammonia accumulation; presents with asterixis, altered consciousness, and fetor hepaticus.
What bedside tests are useful for assessing cognitive function quickly?
Orientation (time, place, person), attention tests (serial 7s, WORLD backwards), and memory recall.
What is the management principle for acute confusion (delirium)?
Identify and treat underlying cause, reorient the patient, ensure hydration/nutrition, avoid physical restraints, and consider low-dose antipsychotics if severely agitated.
What lab tests are essential in assessing a confused patient?
CBC, U&Es, LFTs, glucose, calcium, TSH, vitamin B12/folate, ABG if hypoxia is suspected, and toxicology screen if relevant.
What is the first step in managing acute delirium?
Identify and reverse the cause (e.g., infection, drugs), maintain hydration/nutrition, correct metabolic abnormalities, ensure safety.
What medications can be used for severe agitation in delirium?
Low-dose haloperidol or olanzapine (avoid in Parkinson’s or Lewy body dementia). Use the lowest effective dose for the shortest time.
Which broad classes of drugs are commonly implicated in causing confusion, especially in the elderly?
Anticholinergics, sedatives/hypnotics, opioids, antipsychotics, antidepressants, anticonvulsants, corticosteroids, and polypharmacy in general.
How do anticholinergic drugs cause confusion?
They block acetylcholine in the CNS, impairing cognition.
Examples: antihistamines, tricyclic antidepressants, bladder antimuscarinics.
What sedatives/hypnotics are commonly associated with delirium?
Benzodiazepines (e.g., diazepam, lorazepam) and Z-drugs (e.g., zolpidem, zopiclone), especially in elderly or renally impaired patients.
How do opioids contribute to confusion?
They cause CNS depression, especially in opioid-naive or elderly patients, and may precipitate delirium even at therapeutic doses.
Which anticonvulsants are linked with cognitive impairment and confusion?
Older agents like phenytoin, phenobarbital, and valproate. Also, levetiracetam can cause psychiatric symptoms including confusion.
How do corticosteroids lead to confusion or delirium?
They can cause mood changes, psychosis, insomnia, and confusion, particularly at high doses or in steroid-sensitive individuals.
What antibiotics can cause confusion, especially in renal impairment?
Fluoroquinolones (e.g., ciprofloxacin), cephalosporins, and penicillins can cross the blood–brain barrier and cause neurotoxicity in predisposed patients.
How does polypharmacy lead to confusion?
Through drug–drug interactions, cumulative anticholinergic burden, and altered pharmacokinetics in the elderly (e.g., reduced renal clearance).
