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Flashcards in Psych - Delirium Deck (15)
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1
Q

What is Delirium?

A

Acute Brain Failure

Reversible global impairment of cognitive processes

transient, reversible dysfunciton in cerebral metabolism that has an acute or sub-acute onset and is manifest cliically by a wide array of neuropsychiatric abnormalities

2
Q

Criteria for Delirium?

A
  • Disturbance in attention and awareness that develops over a short period of time
  • Represents a change from baseline attention and awareness
  • tends to fluctuate in severity

Can have additional cognitive disurbances

-Not explained by another preexisting NCD

-Due to substance or to an underlying medical condition

3
Q

What are the cliical features of deliirium?

A
  • Has a Prodrome that is non-specific*
  • Then*

Attentional Deficit - disorganized thinking, rambling, short term memory impairment, etc

Changes in Cognition (memory, orientation, language etc)

Perceptual disturbances

Changes in psychomotor behavior

Abnormal though processes and Labile emotions

Sleep-Wake Cycle Disturbanes

FLUCTUATIONS IN SYMPTOMS!!!!

4
Q

What is difference on EEG in delirium vs NCD?

A

Delirium typically shows diffuse slowing on EEG more commonly than dementia

5
Q

What populations of patients are most at risk for delirium?

A

Post-Cardiac patients

Burn Patients - get burn encephalopathy from breakdown products from skin

Elderly to the ER

Terminally ill cancer patients before death

Stem cell transplant patients

ICU patients

Nursing home patients over age 65

6
Q

Predisposing factors for delirium?

A

AGE - very old and very young

ANY****Pre-existing brain damage or cognitive defects along with drug additiction or sensory deficits

Elevated BUN - Uremia increases BBB permeability

Low Serum Albumin

Medication Exposure

7
Q

What does the EEG show in delirium?

A

Diffuse slowing of dominant alpha waves with the appearance of abnormal slow waves (theta and delta waves)

[*exception - sedative withdrawal delirium]

8
Q

What is the pathophysiology of delirium?

A

Impairment of general attentional mechanisms via the reticuar activating system and its diffuse interaction with the cortex

Reduction in Cholinergic pathway as well

9
Q

What is Wernicke’s Encephalopathy and how does it present?

A

Delerium from Thiamine Deficiency (typically seen in alcoholics)

TRIAD: Delerium, ATaxia, and inability to look laterally

10
Q

Poisoning with what common calssification of drug agents can cause delirium?

A

Anticholinergics!!! Such as Scopolamine or tricyclic andidepressants, antihistamines etc

Bind as a bat, hot as a hare, red as a beet, drug as a bone, mad as a hatter

big pupils and confusion

11
Q

What analgesic is particularly prone to causing delirium?

A

MEPERIDINE!!!!!! it’s metabolite, Normeperidine, causes delirium

Salicylates and anti-inflammatories can also cause it

12
Q

What are some non-specific treatment options while managing the underlying cuase for delirium?

A

Medical - take frequent vitals, serial physical and mental status exams, fluid and nutrition, stop non-essential meds, pain

Psychosocial - increased ambulation

Environmental - familiar objects, reoritentation, frequent toileting

13
Q

What are pharmacologic agents you can give in delirium?

A

Anti-psychotics - Haloperidol –> good for treating delusions and hallucinations or calming agitation

DO NOT GIVE ANTI-CHOLINERGICS OR HYPOTENTIVE DRUGS

Benzos –> Used for withdrawal delirium only!!

14
Q

What are the better anesthetics to use in heart surgery to prophyslactically prevent delirium?

A

Dexmedetomidine - Alpha 2 adrenergic receptor agonist is better than midazolam or propofol

15
Q

What is the main treatment for delirium?

A

TREAT THE UNDERLYING CAUSE!