Organic

Question 1

Delirium behavioural management

Answer 1

Frequent reorientation

Good lighting

Avoid over- or under stimulation

Minimise change

Silence unnecessary noises

Allow safe or supervised wandering

Facilitate regular visits from family/friends

Question 2

Delirium medication

Answer 2

Small night-time dose of benzodiazepines could promote sleep

If short-term sedation is needed, low-dose typical antipsychotics (e.g. haloperidol) or
benzodiazepines can be used

Assess and manage pain appropriately

Question 3

Delirium prevention

Answer 3

Good sleep hygiene

Minimal moves

Encouraging mobility

Prevent polypharmacy interactions

Proactive management (minimise dehydration, pain, constipation, urinary retention and sensory problems)

De-escalation
- short-term (usually <one week) course of haloperidol at the lowest possible dose, gradually titrating the dose against the severity of their symptoms)
- Try oral if possible or use IM route.
- Options: IM haloperidol (first line), IM lorazepam + IM promethazine
- Consider a further dose if there is an initial partial response

Seclusion
Debrief and document

Question 4

Delirium prognosis

Answer 4

Increased mortality

Longer admissions

Higher readmissions rates

Subsequent nursing home placement

May take days to weeks to resolve

Some patients do not return to pre-morbid levels

Question 5

Normal pressure hydrocephalus

Answer 5

Accumulation of CSF around brain and spinal cord, typically presenting with
3 core symptoms - gait disturbance, cognitive dysfunction/dementia, urinary incontinence (wobbly, weird, wet)

Ventriculo-peritoneal shunt is first line