Term
| Where is delirium on the continuum of arousal and awareness? |
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Definition
| alert and awak --> delirium --> stupor --> coma |
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Term
| What is the definition of delirium? |
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Definition
| impaired attention/concentration (can also have change in cognition or perceptual disturbances) |
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Term
| Dementia and delirium are both caused by |
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Definition
| decreased cerebral blood flow and metabolism, chronic inflammation, and cholinergic deficiency |
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Term
| What are the subcategories of delirium based on cause? |
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Definition
| d/t general medical condition, substance intoxication or withdrawal, d/t multiple etiologies, delirium not otherwise specified |
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Term
| What are other terms that describe states similar to delirium? |
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Definition
| ICU psychosis, toxic psychosis, posttraumatic amnesia, acute confusional state |
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Term
| What are the four mechanisms of causes of delirium. |
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Definition
| direct neuronal injury, stress, inflammation, and dopaminergic, cholinergic balance |
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Term
| What are the signs and symptoms of delirium? |
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Definition
| psychomotor behavior (hypo, hyper, or mixed), language impairment (word-finding difficulty, dysgraphia, content), attention |
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Term
| What is the course of depression? |
|
Definition
|
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Term
| What types of hallucinations occur with delirium? |
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Definition
| visual hallucinations usually (can have tactile or auditory hallucinations) |
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Term
| Describe the delusions of delirium. |
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Definition
| fleeting, fragmented, persecutory |
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Term
| Describe the delusions of dementia. |
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Definition
|
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Term
| Describe the delusions of depression. |
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Definition
|
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Term
| Describe the delusions of schizophrenia |
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Definition
| fequent, complex, systematized |
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Term
| What is the prevalence of delirium in hospitalized patients? |
|
Definition
|
|
Term
| What percent of elderly persons in hospitals are delirious? |
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Definition
| 10-15% of admitted; 10-40% during hospitalization |
|
|
Term
| What percent of ICU patients are delirious? |
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Definition
|
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Term
| What exacerbates/predisposes to delirium in the elderly? |
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Definition
| restraints, malnutrition, >3 medications, bladder catheterization |
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Term
| What is the mortality rate of patients with an episode of delirium? |
|
Definition
| 3 month = 23-33%; 1 year = 50% |
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Term
| What is the mortality rate of elderly patients with delirium while hospitalized? |
|
Definition
|
|
Term
| What is the delirium mortality rate in teh pediatric population? |
|
Definition
|
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Term
| How does delirium lead to death? |
|
Definition
| underlying cause of delirium, disturbance of neuronal-endocrine-immunological function, neurochemical abnormalities that damage the brain |
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Term
| What does imaging of delirious patients show? |
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Definition
| hypoperfusion in basal ganglia, thalamus, and cortex |
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Term
| What does cerebrospinal fluid of delirious patients show? |
|
Definition
elevated serotonin metabolites, IL-8, cortisol, lactate
elevated acetylcholinesterase predicts a poor outcome. higher dopamine is associated with more psychosis |
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|
Term
| What does EEG of delirious patient show? |
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Definition
generalized slowing where imporvement in background rhythem parallels clinical improvement
low voltage fast activity is typical of delirium tremens |
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Term
| What are the types of things that cause delirium? |
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Definition
| drug intoxication, drug withdrawal, traumatic brain injury, seizures, metabolic/endocrine disturbance, neoplastic disease, intracranial infection, systemic infection, organ insufficiency, cerebrovascular, other CNS diseases |
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Term
| What metabolic disorders can cause delirium? |
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Definition
| volume depletion/overload, acidosis, alkalosis, hypoxia, uremia, anemia, low B1, B6, B12, folate, elevated A, D hypo/hyperglycemia, hypoalbuminemia, bilirubinemia, hypo/hypercalcemia, hypo/hypernatremia, porphyria |
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Term
| What endocrine disturbances lead to delirium? |
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Definition
| hypo/hyperthyroidism, cushing's syndrome, addison's disease, hypopituitarism |
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|
Term
| What organ insufficiencies cause delirium? |
|
Definition
| cardiac/pulmonary/hepatic/renal/pancreatic |
|
|
Term
| What are cerebrovascular causes of delirium? |
|
Definition
| TIA, SAH, SDH, subdural hematoma, cerebral edema, hypetensive encephalopathy, cerebral vasculuitis |
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|
Term
| What CNS disease lead to delirium? |
|
Definition
| parkinson's disease, Huntington's disease, multiple clerosis, hydrocephalis, lupus cerebritis |
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Term
| After removal or treatment of causative factor, symptoms of delirium usually recede over ________. |
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Definition
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|
Term
| How do you treat delirium? |
|
Definition
| treat underlying cause, restraints, orienting techniques (calendar, frequent reminders, natural lighting, night lights, family), Haloperidol |
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|
Term
| How can haloperidol be administered? |
|
Definition
| po, IM, IV (IM and IV are twice as potent) |
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|
Term
| What is the possible deadly side effect of haloperidol? |
|
Definition
|
|
Term
| What QTc lenths for haloperidol are ok? |
|
Definition
| <450 is ok; 450-500= caution; >500= use something else |
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|
Term
| What is the dosage of haloperidol? |
|
Definition
| 2mg IV Q8 hr and Q4 hr prn (.5 or 1 mg for elderly) |
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