Delirium

Question 1

what percentage of elderly people admitted into hospital are affected by delirium?

Answer 1

30%

Question 2

predisposing factors of delirium?

Answer 2

age> 65
background of dementia
significant injury i.e hip fracture
frailty or multimorbidity
poylpharmacy

Question 3

precipitating events for delirium?

Answer 3

infection: particularly urinary tract infections
metabolic: e.g. hypercalcaemia, hypoglycaemia, hyperglycaemia, dehydration
change of environment
any significant cardiovascular, respiratory, neurological or endocrine condition
severe pain
alcohol withdrawal
constipation

Question 4

features of delirium?

Answer 4

memory disturbances (loss of short term > long term)
may be very agitated or withdrawn
disorientation
mood change
visual hallucinations
disturbed sleep cycle
poor attention

Question 5

management of delirium?

Answer 5

treatment of the underlying cause
modification of the environment
haloperidol 0.5mg first line sedative, olanzapine
parkinsons-atypical antipsychotics- quetiapine and clozapine

Question 6

risk factors of delirium?

Answer 6

recent surgery: narcotic pain medication, benzodiazepines, hypnotics, anticholinergics
underlying disease- dementia, constipation, pneumonia UTI
chronic fatigue

Question 7

theories of delirium?

Answer 7

1. level of neurotransmitter acetylcholine dopamine, glutamate
2. neuronal membrane cant depolarise
3. inflammatory cytokines might interfere with neurons ability to do its job

Question 8

what medications should you avoid due to risk of delirium?

Answer 8

opiates

Question 9

how is delirium different to dementia?

Answer 9

acute onset
hallucinations
delusions
agitated, fear
fluctuating symptoms- worse at night, periods of normality
impairment of consciousness