Delirium case

Question 1

Confustion assessment method needs 2 features plus 3/4

Answer 1

1. Acute onset and fluctuating course
2. Inattention
   MUST HAVE
3. Disorganized thinking OR
4. Altered level of consciousness

Question 2

What is a delusion?

Answer 2

A fixed, false belief not amenable to rational explanation

Question 3

What is a hallucination?

Answer 3

False perception of a sensory stimulus, NOT associated with a real external stimulus (MAY OR MAY NOT be a delusional interpretation)

Question 4

DDx for delusions and hallucinations

Answer 4

1. Delirium
2. Med/neuro condition
3. meds/substance use
4. late dementia - DLB
5. delusional disorder
6. mood disorder
7. schizophrenia

Question 5

Neurotransmitters contributing to delirium

Answer 5

1. Anticholinergics - decrease Ach
2. INCREASE cortisol/beta endorphins
3. INCREASE serotonin (antidepressants)
4. INCERASE Dopamine/decrease Ach (dopamine agonists)
5. DECREASE Gaba - neuronal excitability - bEZOS, alcohol withdrawal