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51 Cards in this Set
- Front
- Back
Why should delirium be discussed? (4)
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Most common PSYCH diagnosis
Carries highest mortality of PSYCH diagnoses Is often iatrogenic Is often misdiagnosed of ignored |
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Prevalence of delirium in medical/surgical inpatients
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15 - 25%
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Delirium pts. have a 6 times greater risk of getting what (2)?
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Decubiti
Aspiration pneumonia |
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Which is more reversible?
Dementia or Delirium |
Delirium
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Which is more chronic?
Dementia or Delirium |
Dementia
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Major DSM characteristics of delirium (5)
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Disturbance of consciousness
Reduced ability to sustain or shift attention Change in cognition or development of perceptual disturbance Develops over a SHORT period of time Waxes and wanes throughout course of the day |
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Throughout a given day, what happens to the symptoms of delirium?
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They wax and wane
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What USED TO BE the focus of a diagnosis of delirium?
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Inability to maintain attention
The focus has shifted to being a disturbance in consciousness |
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What group of antibiotics has been known to cause psychotic symptoms?
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Fluoroquinolones
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What Delirium ISN'T (3)
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Dementia
Depression Schizophrenia |
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What are the most common early findings of delirium on MMSE (2)?
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Impaired attention/concentration
Impaired short-term memory (3 object recall) |
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Why does a normal MMSE NOT exclude delirium?
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Remember, symptoms can wax and wane
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What are the predisposing factors for delirium (5)?
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Brain injury/damage
Severe burn Post-operative state Elderly Drug withdrawal |
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Delirium in the elderly is most often due to what (2)?
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Concurrent illness
Medications |
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Why are elderly more sensitive to medications (6)?
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Decreased neuronal mass
Decline in ACh Decline in DA Decreased lean body mass Increased body fat --> Wider distribution & slower clearance Decreased hepatic metabolism --> longer half-life |
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Concurrent illness in elderly pts. can cause what problems (4)?
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Polypharmacy
Malnutrition Decreased GFR --> decreased renal clearance of drugs Decreased hepatic metabolism |
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% of post-cardiotomy pts. who are delirious
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15 - 70%
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What may reduce risk of post-cardiotomy delirium by as much as 50%?
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Pre-operative PSYCH interview
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Major RFs for post-cardiotomy delirium include (5):
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Age
Time on bypass Increased CNS adenylate kinase Decreased CO Complexity of procedure |
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% of burn patients who are delirious
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18 - 30%
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What is the most frequent neuropsychiatric complication of HIV?
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Delirium
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Mnemonic for Insults that can lead to delirium
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I WATCH DEATH
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'I' part of "I WATCH DEATH"
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Infectious
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'W' part of "I WATCH DEATH"
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Withdrawal
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'A' part of "I WATCH DEATH"
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Acute metabolic
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'T' part of "I WATCH DEATH"
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Trauma
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'C' part of "I WATCH DEATH"
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CNS disease
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'H' part of "I WATCH DEATH"
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Hypoxia
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'D' part of "I WATCH DEATH"
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Deficiencies
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'E' part of "I WATCH DEATH"
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Environmental
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2nd 'A' part of "I WATCH DEATH"
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Acute vascular
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2nd 'T' part of "I WATCH DEATH"
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Toxins/drugs
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2nd 'H' part of "I WATCH DEATH"
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Heavy metals
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Important common effect of many medications assoc. w/ delirium
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Anti-cholinergic effect
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Hepatic failure may affect this, contributing to delirium
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Na/K-ATPase pump
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Renal failure's contribution towards delirium (2)
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Decreased renal clearance of drugs
Increased permeability of the BBB |
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These 3 conditions can lead to changes in brain water volume
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Diabetic Ketoacidosis
Hyperosmolar state Hyponatremia |
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This is usually NOT enough on its own to cause delirium, but it can contribute
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Lack of novel stimulation
(sensory deprivation) |
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How is cerebral metabolic activity changed in delirium?
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It is REDUCED
Reflected in decreased EEG background activity |
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What 3 conditions are exceptions to reduced EEG activity in delirium?
How do these show up on EEG? |
Delirium Tremens (DTs)
HYPERthermia Drug-induced state (ie PCP) LOW voltage, FAST activity (as compared to diffuse slowing) |
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How can BDZs make delirium worse (2)?
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Can make pt. more agitated
May worsen confusion (particularly in elderly) |
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How can Antipsychotics make delirium worse (3)?
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Can lower SEIZURE threshold
Can worsen SEDATION Can worsen agitation (paradoxically) NEED to watch out for neuroleptic malignant syndrome |
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How can Antidepressants make delirium worse (1)?
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Can worsen confusion
NOTE: especially so w/ TCAs |
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What types of Antidepressants are especially bad in delirium?
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TCAs
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What medicine is commonly used for agitation NOT due to drug withdrawal?
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Haldol
NOTE: atypical anti-psychotics are an alternative (Ex. Ripseridone, Quietapine) |
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Symptomatic management for delirium pts. includes (4)
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Placing near nursing station
Frequent reorientation by family, nursing staff, etc. Discontinuation of ALL non-essential meds Daily labs and physicals |
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How is Haldol administered to delirium patients?
(timing of doses) |
Initially, every half-hour until pt. is calm
Eventually, daily dose is consolidated Ultimately, pt. is tapered off of it |
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What type of med is given to pts. who don't respond to Haldol?
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Benzodiazepines
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What needs to be watched for when giving BDZs to delirium pts. (2)?
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Worsening of agitation or confusion
Respiratory depression |
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How are BDZs administered to delirium patients?
(timing of doses) |
Bulk of the dose is given at night
(1/3 in AM, 2/3 in PM) |
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What is the initial focus in treating a delirium pt.?
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Diagnosing and treating the underlying conditions causing the delirium
Focus more on conditions that increase morbidity/mortality |