Delirium / Acute Confusional State

Question 1

Definition of Delirium

Answer 1

Delirium is a common clinical syndrome characterised by disturbed consciousness, cognitive function or perception, which has an acute onset and fluctuating course.

Delirium has many descriptive terms:
• Acute Confusional State • Agitation
• Altered Mental Status
• Confusion

Question 2

Delirium can be classified based on symptoms into three sub types:

Answer 2

• Hyperactive – hyperalert: restless +/- agitation
• Hypoactive – hypoalert: lethargic, confused, slow to respond
• Mixed delirium – most common type
Often not recognised by clinicians 2/3 cases missed universally delirium is poorly diagnosed, poorly managed, leading to poor patient outcome, delays in treatment, increased LOS

Question 3

Delerium: Predisposing & Precipitating factors

Answer 3

• Advanced Age
• Pain
• Infection
• Constipation
• Hydration and other metabolic abnormalities • Medication
• Environmental changes
• Cognitive Impairment
• Poor Nutrition
• Cardiovascular Events
• Sensory & sleep deprivation

Question 4

Measurement of Delirium

Answer 4

• Confusion Assessment Method – CAM the most widely used & studied.
• The collation of information from family or care givers being essential to support competent assessment
• Complete a Mental Capacity Assessment for each decision asked of the patient, e.g accepting medical & nutritional intervention, remaining in a place of safety, discharge destination
• Staff should have an understanding of Deprivation of Liberty.
• Repeating the Assessment is vital

Question 5

Delirium Vs. Dementia

Answer 5

Dementia
• Insidious onset (with the exceptions of hypoxia, trauma, or stroke- induced dementia)
• Stable level of consciousness
• Incurable and life long
• Visual hallucinations are
rare initially

Delirium 
  • Acute onset
• Fluctuating level of
consciousness
• Usually curable and brief
• Visual hallucinations are
common

Question 6

Management of Delirium

Answer 6

• Prevention – components such as staff education to increase awareness increasing early recognition and identification
• Pharmacological interventions have proven successful in reducing post operative delirium such as anti psychotics (caution)
• Managing patients with delirium is challenging requiring a comprehensive MDT approach.
• Non pharmacological strategies such as reorientation, behavioural and or environmental interventions, avoidance of restraint.
• Enhanced observation – interactive, occupational, address all physical needs
• Routine ongoing assessment of mental status and cognition