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33 Cards in this Set

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What are the 4 core signs/symptoms of delirium?

1. Disturbance in cognition

2. Fluctuations

3. Reduced awareness

4. Changes in psychomotor behavior

What is asterixis?

A wrist tremor noticeable when arms are extended. Looks like hand flapping, often induced by pushing back on the patient's fingers and hyper extending their wrist.

Often observed with delirium in hepatic encephalopathy, opiate use, or Wilson disease.

What is the pneumonic for differential diagnosis of conditions causing delirium, and what does each letter mean?


I is Infection

W is Withdrawal

A is Acute metabolic (organ failure, acidosis)

T is Trauma

C is CNS pathology (e.g., tumor, cyst, stroke)

H is Hypoxia

D is Deficiencies (nutritional)

E is Endocrinopathies (hypoglycemia)

A is Acute vascular

T is Toxins or drugs

H is Heavy metals

Are structural or neurotransmitter changes typically implicated in delirium?


Which neurotransmitters are typically implicated in delirium?

Dopamine and Acetylcholine

Does an increase or decrease in acetylcholine cause delirium?

DECREASE, which is why anticholinergic drugs can induce memory and concentration problems at the level of a delirium.

Does an increase or decrease in dopamine cause delirium?

INCREASE. Dopamine agonists are often used to treat delirium. Dopamine enhancing drugs like levadopa and buproprion can increase delirium.

What symptoms of delirium are typically induced by excess dopamine?

Visual hallucinations, paranoia, and confusion

What is serotonin syndrome?

Excess use of serotonergic agents that results in:

1. Mental status changes

2. Agitation

3. Myclonus

4. Diaphoresis (sweating)

5. Diarrhea (we all know what this is)

6. Tremor

7. Fever

8. Incoordination

9. Hyperreflexia

What are the 4 major predisposing factors for delirium?

1. Older age

2. Pre-existing cognitive impairment or brain disease

3. Comorbid physical problems (e.g., sleep deprivation, dehydration)

4. Medical comorbidities (e.g., diabetes, hepatic or renal disease,

What are 3 major precipitating causes of delirium?

1. Postoperative states (particularly hyponatremia, post-transplants)

2. Acute injuries (polytrauma, burns, metabolic alterations)

3. Drug withdrawal or anticholinergic drugs

Is hyperactive or hypoactive delirium more common?


What is hyperactive delirium?

Increased motor activity, restlessness, stereotyped behaviors, agitation

What is hypoactive delirium?

Lethargy, slow reaction time, lack of initiation.

What is the nature of hallucinations in delirium when they occur?

They are erratic, non-systematic, tend to be VISUAL or TACTILE.

Not like in psychotic disorders

What is the most common cause of delirium in young adults?



What is the most common cause of delirium in older adults?


What percentage of hospitalized patients in the ICU or critical care experience delirium? How about nursing homes?



What 3 surgical procedures are associated with high rates of delirium?


Hip surgery

Vascular operations

What percentage of patients experience persisting cognitive impairment after delirium?


What happens to the sleep-wake cycle in delirium?

It flips. Agitation at night, lethargy during the day.

What are common drugs to treat delirium?

1. Antipsychotics
2. Depakote
3. Benzos
4. Drugs that counteract substances

What type of orientation is typically unaffected in delirium?

Orientation to self

Time and place are affected, though.

What are the core features of delirium tremens?


Autonomic hyperactivity


What is Neuroleptic Malignant Syndrome?

A rare complication following neuroleptic use

1. Muscle rigidity*

2. Pallor*

3. Dyskinesia*

4. Hyperthermia

5. Incontinence

6. Tachycardia

7. Unstable blood pressure

8. Pulmonary congestion

What is the formal term for sundowning?

Dementia with delirium

What is more typical postoperatively, Hypo- or Hypernatremia?


Hyper does not occur postoperatively

What is a common cause of persisting cognitive problems following severe sepsis and its resolution?

Ischemic lesions and hemorrhages

What is a difference in hallucinations between those with schizophrenia and those with delirium?

Delirium is non-systematic.

Those in schizophrenia also tend to be auditory.

What cognitive and psychiatric factors are most predictive of postoperative delirium?

Executive dysfunction


How long does post-ictal delirium usually last?

5-30 minutes

What other substance is benzo withdrawal similar to?

Alcohol withdrawal

If a patient is experiencing persistent general (not focal) deficits following a CABG surgery, what is the most likely the cause?

Embolic shower