Delirium Flashcards
What are the hallmark features of delirium?
- impairment of consciousness
- disturbance of cognition
- psychomotor disturbance
- disturbance of sleep-wake cycle
- emotional disturbance
What are the general features of delirium?
Rapid onset, transient, fluctuating course, lasts days to months depending on underlying cause
What is the ICD 10 criteria for delirium?
Impaired consciousness and attention
Perceptual disturbance or cognitive disturbance
Developed over a short period and fluctuates
Evidence of physical cause
State the causes of delirium
Drugs Withdrawal Metabolic Infections Head trauma Epilepsy Neoplastic Diseases Vascular Disorders
State the risk factors for delirium
Age Cognitive deficit Previous episode Post surgery Extremes in sensory experience Sensory deficits Immobility Stress/new environment/isolation
What investigations can be done in delirium?
Important to find the underlying cause Cognitive testing Urinalysis FBC/U and Es LFTs Thyroid Blood glucose CRP B12/folate CXR MRI/CT (for ischaemic causes) Consider EEG if epilepsy is a differential
Describe the 4AT test
Alterness (normal/mild sleepiness on waking or clearly abnormal)
AMT4 (age, DOB, place, current year)
Attention (months of the year backwards)
Acute change/fluctuating course
What are the four key management points in delirium?
Identify and treat the cause
Mange environment and provide support
Prescribe
Review
Describe the appropriate environment for a patient with delirium
Quiet, sort out sensory impairment, appropriate lighting, minimal staff changes, supply basic need, clocks and calendars
What medication can be given in delirium?
Antipsychotic - low dose haloperidol
Sedation can make it worse - if benzodiazepine required use lorazepam not diazepam
How long does delirium typically last?
1-4weeks
Name three subtypes of delirium
Hyperactive
Hypoactive
Mixed
Describe hyperactive delirium
Elderly patients with recent injury, sudden onset new confusion often at night time. Very disruptive agitated and have delusions or visual hallucinations
Describe hypoactive delirium
Suddenly quiet, withdrawn, sleepy, fluctuates, stops eating/drinking and not engaging with rehab. May seem depressed.
Describe mixed delirium
Mild variation in 24 hour period, sleep all day and was all night, lucid intervals
