Define Delirium
Acute reversible state of confusion
What is the DSM criteria for Delirium?
- disturbed level of consciousness and reduced ability to control attention
- change in cognition
- disturbance caused by general medical condition
- develops over a short period of time and fluctuates in severity during the course of a single day
What would you use to screen for Delirium?
The Confusion Assessment Method (CAM)
What are the criteria for Delirium in CAM?
- acute onset and fluctuating course
- inattention/hyperattention
- disorgansied thinking/FTD
- altered level of consciousness
must have 1. and 2. +/- 3. or 4.
What is the most common risk factor for Delirium?
Dementia
What are the most common risk factors for delirium?
dementia, advanced age (>80), polypharmacy, malnutrition, multiple comorbidities, infection, post-operative
What symptoms can be associated with Delirium?
- Psychotic symptoms: hallucinations, delusions
- Emotional incontinence
- poor cognition: disorientated to time of day
- Diurnal features
What are the subtypes of Delirium? and what are they associated with?
Hyperactive delirium (angry delirium) - associated with anticholinergic medications, drug intoxication and withdrawal
Hypoactive delirium (sleepy delirium) - metabolic causes
Mixed delirium
What are the most common causes of delirium?
medications, alcohol/BNZ withdrawal, infections, hyponatraemia, CVD, , sleep deprivation, constipation
How do you manage delirium?
- treat cause
- haloperidol 0.25-0.5mg, OR
- risperidone 0.25-3mg, OR
- quetiapine 25mg -only in Parkinson’s disease
Why should you not treat delirium with benzodiazepines? (except in benzo withdrawal)
because they lower the seizure threshold
What are the tests for frontal lobe function?
- name ten things you can buy at the supermarket
- name the similarities of two objects
- proverbs
