Lecture 24 - Delirium Flashcards
what is the basic definition of delirium and how does this compare to dementia?
ACUTE BRAIN FAILURE vs (dementia (chronic bran failure))
§ Overall -- psychiatric manifestations of acute loss of attention and awareness that is caused by another medical condition, substance
DSM Criteria for Delirium Dx
○ Disturbance in attention and awareness , which tends to fluctuate in severity throughout the course of the day
§ Develops over short period of time
○ + Additional disturbance in cognition
○ Not better explained by another pre-existing neurocognitive disorder
Evidence (History, Physical, labs) that the disturbance is a direct physiological consequences of another medical condition, substance intoxication or withdrawal, exposure to a toxin
what are 2 subtypes of delirium
Hyper and Hypoactive
how is attention deficit assessd?
what other changes in cognition might be present?
Mini Mental, MoCA, serial 7s, clinically
Memory, disorientation, language, apraxia, halluciations
how common is delirium
who is at higher risk?
- Vey Common
- 6-56% in hospitalized Patients;
- 1/3 and 2/3s of cases are missed
Risk: post cardiotomy, burns, elderly, terminal cancer, ICU,
Describe the general pathophysiology —
what brain sturcutres are affected first?
Inadequate oxidative metabolism
○ Demand often increases in illness
○ Brain structures - first affected
§ hippocampus
§ Neocortex
which NT is most implicated with Delirum
○ The NTs
§ Reduction in Cholinergic Activity –
□ Excess Dopamine may be harmful
Complicatins of delirium?
Agitation
Injuries
Increased length of stay
• Emergency Etiologies to rule out at the bedside
what is the triad for wernicke’s
what drugs implicated for withdrawal?
WWHHHIMP
Wernicke’s (Delirium, Ophthalmoplegia (can’t look laterally), Ataxia )
Withdrawal (ETOH, Barbs, Benzo)
Hypertensive Hypoglycemia Hypoperfusion Intracranial bleed Meningitis Poisons
Other etiologies ?
Drug Intox Infection Trauma Cancer Paraneoplastic Syndrome
what medications are particularly deliriogenic?
Anitcholinergics
MEPERIDINE (normeperidine metabolite is very deliriogenic)
what is the mortality for a delirious patiet?
40% die within 1 year of dx
when do you image?
if there is no obvious cause of the dementia
Treatment of dilirum?
• Treating the etiology – eg the the HTN or the PNA
• Nonspecific Treatment for Delirium -- Medical -- frequent vitals, check fluids, maintain nutrition,
Psychosolcal
Environmental
Pharmacological – Hloperidol,
when are benzodiazepines used for treatment of delirium?
ONLY FOR WITHDRAWAL DELERIUM
