Delirium

• What is delirium?

  Acute & fluctuating disturbance in attention & cognition

  Often accompanied by a change in consciousness

  Typically reversible
• What are the 3 subtypes of delirium?

  Hyperactive -> increased psychomotor activity, restlessness, agitation & hallucinations

  Hypoactive -> lethargy, reduced responsiveness & withdrawal

  Mixed
• What are the potential causes of delirium?

  PINCH ME

  Pain

  Infection

  Nutrition

  Constipation/continence

  Hydration

  Medication (anticholinergics, opiates, anti-convulsants, recreational)

  Environment
• What are the RFs for delirium?

  Age

  Pre-existing cognitive impairment

  Sensory impairment

  Multiple comorbidities (esp cardiac, renal or hepatic)
• What are the signs & symptoms of delirium?

  Disorientation

  Hallucinations (visual or auditory)

  Inattention

  Memory problems (esp. short-term, orientation & language)

  Change in mood/personality (sundowning -> agitation & confusion worsening in late afternoon/evening)

  Disturbed sleep

  NOTE: hypoactive delirium may be easy to miss as pts seem more withdrawn
• What are the Inx for delirium?

  Full Hx (if possible)

  4AT & CAM (for delirium assessment)

  Initial physical examination & investigations

  Bladder scan

  Review meds

  ECG

  Urinalysis

  Bloods (FBC, U&Es, LFTs, TFTs, cultures)

  CXR

  Abdo USS

  CT/MRI
• What is 4AT?

  4AT is a rapid assessment tool used to screen for delirium

  • alertness
  • AMT4 (age, DOB, place, year)
  • attention
  • acute change or fluctuating course
• What is CAM?

  Confusion Assessment Method -> used to identify delirium

  4 criteria

  • acute onset & fluctuating course
  • inattention
  • disorganised thinking
  • altered levels of consciousness
• What are the DDx of delirium?

  Dementia

  Depression (major depressive disorder)

  Psychosis
• What is the management of delirium?

  Treat underlying cause

  Provide environment with good lighting

  Maintain regular sleep-wake cycle

  Regular orientation & reassurance

  Ensure pt's glasses & hearing aids are used (if needed)

  Extreme agitation & potential danger -> small doses of haloperidol & lorazepam (should be used with caution)
• Delirium may take months to resolve after treating the underlying cause.