Term
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Definition
-delirium is a transient, reversible cerebral dysfunction that has an acute or subacute onset and is manifest clinically by a wide range of fluctuating mental status abnormalities ("acute brain failure")
-in short, something acutely wrong with the functioning of the brain |
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Term
| *delirium and medical care* |
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Definition
| **delirium is a serious medical illness and the patient should be under direct medical care to treat the underlying cause** |
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Term
| mental status abnormalities in delirium |
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Definition
-global cognitive impairment in: thinking, memory, perception
-decreased attention
-change in the level of consciousness
-agitation or decreased motor activity
disturbances in the sleep-wake cycle |
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Term
| why is it important to know about delirium? |
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Definition
-it's common
-it can be the presenting feature of a fatal or serious illness
-delirious patients can be dangerous to themselves and others
-physicians often fail to recognize it
-it is stressful to patients and families
(always think about the patient's mental status!) |
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Term
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Definition
-10-30% of hospitalized medical/surgical patients
-patients are usually really sick to go into delirium
-certain patient populations are predisposed to delirium |
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Term
| patient populations predisposed to delirium |
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Definition
-elderly (esp. pt's with dementia)
-post cardiotomy
-burn
-preexisting brain disease
-drug withdrawal
-AIDS |
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Term
| clinical features of delirium |
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Definition
-prodromal symptoms: restlessness, disrupted sleep, anxiety, irritability
-fluctuating course: moment to moment
-attentional deficits (distractable)
-altered arousal and psychomotor abnormailities
-sleep/wake disturbance
-impaired immediate/recent memory
-disorganized thinking, speech
-disorientation (time>>place)
-altered perceptions
-neurologic abnormalities
-emotional disturbances |
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Term
| clinical features of delirium: neurologic abnormalities |
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Definition
-dysgraphia
-dysnomic aphasia (can't name things)
-constructional abnormalities (can't copy figures)
-motor abnormalities (unsteady gait, tremors)
-EEG changes: diffuse slowing, low voltage, fast activity in hyperactive, agitated patients |
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Term
| clinical features of delirium: emotional disturbances |
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Definition
-anxiety
-panic
-fear
-anger
-sadness
-depression
-apathy
-euphoria (w/ steroid delirium) |
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Term
| differential diagnosis of delirium |
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Definition
-psychoses (schizo, mania), can helped to be differentiated base of EEG (abnormal in delirium)
-dementia |
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Term
| delirium vs. dementia: onset |
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Definition
delirium: acute onset
dementia: insidious, develops over time, can be very subtle |
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Term
| delirium vs. dementia: disease course |
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Definition
delirium: fluctuation
dementia: stable over the day |
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Term
| delirium vs. dementia: duration |
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Definition
delirium: lasts hours to days
dementia: chronic |
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Term
| delirium vs. dementia: alertness |
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Definition
delirium: low or hyper-alert
dementia: normal alertness |
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Term
| delirium vs. dementia: attention |
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Definition
delirium: distractible
dementia: attention is normal |
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Term
| delirium vs. dementia: orientation |
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Definition
delirium: impaired orientation for time, mistake unfamiliar for the familiar
dementia: impaired orientation |
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Term
| delirium vs. dementia: memory |
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Definition
delirium: immediate, recent memory impairment (often don't have memory of while they were delirious)
dementia: global memory impairment |
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Term
| *delirium vs. dementia: thinking |
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Definition
delirium: disorganized thinking
dementia: impoverished thinking (unable to form thoughts/express themselves in a normal way) |
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Term
| delirium vs. dementia: perceptual disturbances |
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Definition
delirium: illusions, hallucinations (often based of real perceptual confusion)
dementia: perceptual disturbances are rare |
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Term
| pathophysiology of delirium |
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Definition
-not clear
-likely a cholinergic deficit
(cholinergics --> needed for thinking, sleep/wake cycle, attention...) |
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Term
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Definition
MANY!
-various deficiencies, infections, toxins, meds, etc can cause delirium
-some causes are life-threatening |
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Term
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Definition
possible outcomes:
-recovery
-progression to stupor or coma
-chronic brain syndrome (dementia)
-death
(-chronic delirious state) |
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Term
| morbidity & mortality in delirium |
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Definition
-both are HIGH
-increase may be due to the fact that these patients are already REALLY SICK |
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Term
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Definition
Confusion Assessment Method CAM) Instrument
-bedside tool to diagnose delirium
-diagnostic algorithm based on 9 clinical features of delirium
-acute onset (feature 1) and inattention (2) must be present
-must be associated with disorganized thinking or altered level of consciousness
-takes about 5 minutes to administer |
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Term
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Definition
-MSE
-physical status-->most important to check at the bedside (vitals, neuro exam)
-records review: time course of behavior change, meds
-labwork |
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Term
| labwork involved in evaluation of delirium |
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Definition
Basic labs: chem panel, CBC, drug/tox screen, urinalysis
Labs based on clinical presentation: EKG, CXR, EEG, brain imaging, LP, additional chemistries |
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Term
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Definition
-treat underlying medical cause(s)
-assure patient/staff safety: sitters, restraints (when needed)
-close monitoring of vitals and labs
-minimize all meds
-pharmacological management
-psychosocial support and education
-environmental approached: having family, familiar items around |
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Term
| pharmacological management of delirium |
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Definition
-Haloperidol
-Risperidone
-Benzodiazepines |
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Term
| Delirium - take home points |
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Definition
~Delirium is transient, reversible cerebral dysfunction with acute or subacute onset, manifested clinically by a wide range of fluctuating mental status abnormalities
Important to:
-pay attention to patient's mental status to help recognize delirium early
-evaluate for potential causes
-treat underlying conditions
-intervene to keep the patient safe |
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