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51 Cards in this Set

  • Front
  • Back
Why should delirium be discussed? (4)
Most common PSYCH diagnosis
Carries highest mortality of PSYCH diagnoses
Is often iatrogenic
Is often misdiagnosed of ignored
Prevalence of delirium in medical/surgical inpatients
15 - 25%
Delirium pts. have a 6 times greater risk of getting what (2)?
Aspiration pneumonia
Which is more reversible?

Dementia or Delirium
Which is more chronic?

Dementia or Delirium
Major DSM characteristics of delirium (5)
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
Throughout a given day, what happens to the symptoms of delirium?
They wax and wane
What USED TO BE the focus of a diagnosis of delirium?
Inability to maintain attention

The focus has shifted to being a disturbance in consciousness
What group of antibiotics has been known to cause psychotic symptoms?
What Delirium ISN'T (3)
What are the most common early findings of delirium on MMSE (2)?
Impaired attention/concentration
Impaired short-term memory (3 object recall)
Why does a normal MMSE NOT exclude delirium?
Remember, symptoms can wax and wane
What are the predisposing factors for delirium (5)?
Brain injury/damage
Severe burn
Post-operative state
Drug withdrawal
Delirium in the elderly is most often due to what (2)?
Concurrent illness
Why are elderly more sensitive to medications (6)?
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
Concurrent illness in elderly pts. can cause what problems (4)?
Decreased GFR --> decreased renal clearance of drugs
Decreased hepatic metabolism
% of post-cardiotomy pts. who are delirious
15 - 70%
What may reduce risk of post-cardiotomy delirium by as much as 50%?
Pre-operative PSYCH interview
Major RFs for post-cardiotomy delirium include (5):
Time on bypass
Increased CNS adenylate kinase
Decreased CO
Complexity of procedure
% of burn patients who are delirious
18 - 30%
What is the most frequent neuropsychiatric complication of HIV?
Mnemonic for Insults that can lead to delirium
'I' part of "I WATCH DEATH"
'W' part of "I WATCH DEATH"
'A' part of "I WATCH DEATH"
Acute metabolic
'T' part of "I WATCH DEATH"
'C' part of "I WATCH DEATH"
CNS disease
'H' part of "I WATCH DEATH"
'D' part of "I WATCH DEATH"
'E' part of "I WATCH DEATH"
2nd 'A' part of "I WATCH DEATH"
Acute vascular
2nd 'T' part of "I WATCH DEATH"
2nd 'H' part of "I WATCH DEATH"
Heavy metals
Important common effect of many medications assoc. w/ delirium
Anti-cholinergic effect
Hepatic failure may affect this, contributing to delirium
Na/K-ATPase pump
Renal failure's contribution towards delirium (2)
Decreased renal clearance of drugs
Increased permeability of the BBB
These 3 conditions can lead to changes in brain water volume
Diabetic Ketoacidosis
Hyperosmolar state
This is usually NOT enough on its own to cause delirium, but it can contribute
Lack of novel stimulation
(sensory deprivation)
How is cerebral metabolic activity changed in delirium?

Reflected in decreased EEG background activity
What 3 conditions are exceptions to reduced EEG activity in delirium?

How do these show up on EEG?
Delirium Tremens (DTs)
Drug-induced state (ie PCP)

LOW voltage, FAST activity
(as compared to diffuse slowing)
How can BDZs make delirium worse (2)?
Can make pt. more agitated
May worsen confusion (particularly in elderly)
How can Antipsychotics make delirium worse (3)?
Can lower SEIZURE threshold
Can worsen SEDATION
Can worsen agitation (paradoxically)

NEED to watch out for neuroleptic malignant syndrome
How can Antidepressants make delirium worse (1)?
Can worsen confusion

NOTE: especially so w/ TCAs
What types of Antidepressants are especially bad in delirium?
What medicine is commonly used for agitation NOT due to drug withdrawal?

NOTE: atypical anti-psychotics are an alternative
(Ex. Ripseridone, Quietapine)
Symptomatic management for delirium pts. includes (4)
Placing near nursing station
Frequent reorientation by family, nursing staff, etc.
Discontinuation of ALL non-essential meds
Daily labs and physicals
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
What type of med is given to pts. who don't respond to Haldol?
What needs to be watched for when giving BDZs to delirium pts. (2)?
Worsening of agitation or confusion
Respiratory depression
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)
What is the initial focus in treating a delirium pt.?
Diagnosing and treating the underlying conditions causing the delirium

Focus more on conditions that increase morbidity/mortality