Questions and Answers
Delirium has a worse prognosis in younger individuals compared to the elderly.
False
Patients with a hyperactive behavioral profile generally have a better outcome than those who are hypoactive.
True
The mortality rate following an episode of delirium is estimated at 50% after 3 months.
False
A meta-analysis found a fivefold increase in the incidence of dementia 2 years after experiencing delirium.
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Delirium acts independently of underlying dementia-related neuro-pathology.
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Elderly patients who experience delirium do not have an increased risk of death over the following 2 years.
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Delirium has a prevalence of 1-2% in elderly community samples.
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The cardinal feature of delirium is significant visual acuity.
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Rates of delirium in emergency departments can reach up to 17%.
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Delirium is more common in younger people than in the elderly.
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Symptoms of delirium include both hyperactive and hypoactive presentations.
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Perceptual anomalies such as illusions are uncommon in patients with delirium.
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The term 'acute organic syndrome' is synonymous with delirium.
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Visual hallucinations in delirium are typically highly detailed and elaborated.
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Dementia is a predisposing factor for delirium.
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Only substance-related factors can precipitate delirium.
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Alcohol misuse is considered a predisposing factor for delirium.
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The Confusion Assessment Method is not frequently used as a delirium screening tool.
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Dehydration is included among the physiological causes of delirium.
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Delirium typically presents with a gradual onset of symptoms.
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Hypoglycaemia and hyperglycaemia are both considered neurological causes of delirium.
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Older age is a known risk factor for developing delirium.
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Delirium is classified as a non-emergency medical condition.
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Antipsychotics are considered the mainstay of treatment for delirium.
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Regular measurement of vital signs is important in the management of delirium.
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Medication for agitation and distress in delirium patients should be used freely without limitations.
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Haloperidol is traditionally used for managing delirium and should be started at a high dose.
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Delirium associated with alcohol withdrawal should typically be treated with benzodiazepines.
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Complete avoidance of antipsychotics is recommended for all patients with coexisting dementia.
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Regular family visits can help manage a patient with delirium.
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Routine blood tests for delirium include tests for liver function and calcium levels.
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Antipsychotics have no known adverse effects when used in delirium treatment.
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Study Notes
Delirium Overview
- Delirium is an acute, global impairment of consciousness, leading to reduced alertness, attention, and perception.
- Other terms include acute confusional state, acute brain failure, and acute organic syndrome; delirium is preferred in clinical classifications (ICD-10, DSM-5).
Epidemiology
- Prevalence of delirium:
- 1-2% in community-dwelling elderly
- 8-17% in emergency departments
- 18-35% at hospital admission
- 29-64% among inpatients
- Higher occurrence in elderly and those with diminished cerebral reserve, such as pre-existing dementia.
- Associated with significant adverse outcomes, highlighting the importance of prompt recognition and treatment.
Clinical Features
- Cardinal feature: disturbed consciousness, with symptoms like drowsiness and decreased awareness.
- Other manifestations include:
- Disorientation in time and space
- Mental slowness and distractibility
- Perceptual anomalies and disorganized sleep-wake cycle.
- Symptoms can vary widely and fluctuate throughout the day.
- Behavioral symptoms: hyperactivity or hypoactivity, agitation, irritability, and emotional lability.
- Common symptoms: delusions, hallucinations, anxiety, and depressive features.
Outcomes
- Recovery often occurs rapidly, influenced by the underlying cause, age, and pre-existing health conditions.
- Elevated mortality rate following delirium, with about 25% dying within 3 months.
- A meta-analysis revealed a twofold increased risk of death within 2 years following delirium.
Delirium and Dementia Relationship
- Pre-existing dementia is a major risk factor for developing delirium.
- Episodes of delirium increase the risk of dementia onset, with a fivefold increase in incidence noted after an episode.
- Evidence shows that delirium can accelerate cognitive decline in those with underlying dementia pathology.
Predisposing and Precipitating Factors
Predisposing Factors
- Dementia and previous delirium episodes
- Functional impairment and sensory impairment
- History of cerebrovascular disease, alcohol misuse, increased age
Precipitating Factors
- Substance-related: medications (e.g., steroids, psychotropics), alcohol intoxication, use of multiple drugs
- Physiological causes: infections, hypoxia, organ failure, metabolic changes, dehydration
- Neurological causes: post-ictal state, head injury, sleep deprivation, use of restraints
Clinical Features of Delirium
- Clouding of consciousness, impaired attention, and disorientation.
- Rapid onset and fluctuation in symptoms over a 24-hour period.
- Changes to sleep-wake cycle often observed.
Aetiology
- Most cases are multifactorial; common causes include drugs and infections.
- Pathophysiology remains unclear, but cerebral rhythm disturbances and neurotransmitter involvement (dopamine, acetylcholine) are noted.
Management of Delirium
Prevention
- Effective interventions exist for preventing delirium.
Treatment
-
Considered a medical emergency; requires identifying and treating underlying causes.
-
Non-pharmacological measures preferred, including:
- Frequent reorientation and reassurance
- Maintaining a quiet, familiar environment
- Encouraging family visits
-
Medication:
- Antipsychotics, like haloperidol, used for severe agitation or distress, with caution in elderly patients.
- Atypical antipsychotics also prescribed, avoiding use in certain conditions like alcohol withdrawal.
Investigations for Delirium
Blood Tests
- Full blood count, renal and liver function tests, electrolyte levels, blood cultures, arterial blood gas.
Other Tests
- Urinalysis, chest X-ray, drug screening, brain imaging (MRI/CT), EEG, lumbar puncture as needed.
- Regular monitoring of vital signs is essential.
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Description
This quiz covers the essential aspects of delirium, including its definition, symptoms, and management strategies. Delirium is characterized by global impairment of consciousness and various terms related to it. Understand the nuances and implications of this condition as defined in ICD-10 and DSM-5.
