Delerium

Question 1

What are the characteristics of delerium?

Answer 1

• Acute changes in mental status
• Waxing and waning course
• Usually attributable to other medical factors
• Primary disturbance in attention and awareness (altered consciousness with reduced ability to focus, sustain, or shift attention)
• Is a medical syndrome(with behavioral symptoms), not a disease
  
  • Often mistaken for psychiatric illness
  • Can be viewed as a failure of brain to maintain homeostasis

Question 2

(T/F) Delirium can increase mortality rates in affected patients. Approximately 10% of patients affected by delirium experience mortality within 1 year if the delirium is ongoing

Answer 2

Delerum does increast mortality rates. However, approximately 50% of patients experience mortality within 1 year.

Question 3

What are some of the most common signs of delirium in a patient?

Answer 3

• Disorientation (shows up first, unlike dementia)
• Lapses in short and long-term memory
• Confusion
• Hyper- or hypoactive motor function
• Reduced comprehension, word-finding difficulties, mumbling, muteness
• Circadian rhythm abnormalities
• Dysphoria
• Illusions and hallucinations (mainly visual, unlike schizophrenia)
• Delusions (usually paranoia)
• Distractibility, poor attention/focus, losing train of thought

Question 4

(T/F) Delirium symptoms in a patient are constant and persistent once they appear.

Answer 4

False. Delirium symptoms are waxing and waning

Question 5

What is the mnemonic used for possible causes of delirium?

Answer 5

“I WATCH DEATH”

• Infection
• Withdrawal
• Acute metabolic (acidosis/alkalosis, electrolyets, hepatic/renal failure)
• Trauma
• CNS pathology
• Hypoxia
• Deficiencies (Cobalamin (B12), Folate (B9), Niacin (B3), Thiamine (B1))
• Endocrinopathies
• Acute vascular
• Toxins or drugs
• Heavy metals

Question 6

The biggest risk factor for delirium is _________.

Answer 6

Age, others include:

• Dementia
• CNS injury
• Mutiple medical problems
• Multiple meds
• Malnutrition
• Low serum albumin
• Alchol/drug use
• Visual/hearing impairment
• Immobilization
• Sleep deprivation

Question 7

What medications in particular should you look for when assessing a patient suspected of delirium?

Answer 7

• Anticholinergics
• Opiates
• Benzodiazepines

Question 8

What class of medications is considered the most“deliriogenic”?

1. Anticholinergics
2. Antipsychotics
3. Benzodiazepines
4. Opiates

Answer 8

1. Anticholinergics

• ACh is primary NT of CNS
• Messes up homeostasis
• Benedryl (diphenhydramine) is most common

Question 9

(T/F) Delirium occurs when there is a failure to maintain homeostasis in a patient with a “vulnerable brain”.

Answer 9

True. Any significant change from baseline in the body may cause delirium.

Question 10

What antipsychotic medication is most often used in patients with delerium?

Answer 10

Haloperidol

• Few anticholinergic side effects
• Few acitve metabolites
• Adverse effects:
  
  • EPS and QTc prolongation

Question 11

(T/F) You should avoid giving benzodiazepines to a delirium patient at all costs.

Answer 11

True.

Question 12

Resolution of delirium can lag (days to weeks/months to years) behind resolution of the medical causes.

Answer 12

Days to weeks

Question 13

What are some ways to prevent delirium on admission?

Answer 13

• Be mindful of vulnerable patients when using “standard order” drugs
• Prevent urinary tract infections (Minimize use of foley catheters)
• Review med list and decrease unneeded and high-risk meds
• Maintain orienting cues and encourage family presence

Question 14

What is another diagnosis, other than delirium, that commonly presents with mental status changes and hallucinations 24-72 hours after admission to the hospital?

1. Pancreatitis
2. Congestive heart failure
3. Meningitis
4. Alcohol Withdrawal

Answer 14

4. Alcohol Withdrawal (Delirium Tremens)
   * Treat with benzodiazepines (unlike delerium)

Question 15

Besides haloperidol, delirium may also be treated with the _______________ group of antipsychotics.

Answer 15

Atypical antipsychotic

Question 16

Delirium has a(n) (acute/gradual) onset.

Answer 16

Acute

Question 17

In delirium patients, the course of the disorder is (progressive/fluctuating).

Answer 17

Fluctuating

Question 18

In delirium patients, consciousness is (intact/impaired).

Answer 18

Impaired

Question 19

In delirium patients, attention is (intact/impaired).

Answer 19

Impaired

Question 20

Delirium is (reversible/irreversible).

Answer 20

Reversible

Question 21

Hallucinations are (common/rare) in patients experiencing delirium.

Answer 21

Common

Question 22

In delirium patients, the circadian rhythm is (normal/reversed).

Answer 22

Reversed, most often.

Question 23

What are some drugs that can cause delerium?

Answer 23

• Diphenydramine (benadryl) - anticholinergic
• Amitriptyline
• Cimetidine, Ranitidine
• Digoxin
• Furosemide
• Nifedipine
• Prednisone
• Promethazine
• Theophylline