Neurology Book

http://www.fpnotebook.com/

Delirium

Advertisement

  1. See Also
    1. Altered Level of Consciousness
    2. Delirium in Cancer
  2. Definition
    1. Acute Confusional State
  3. Risk Factors
    1. Age over 60 years
    2. Drug or Alcohol addiction and withdrawal
    3. Prior brain injury (vascular or traumatic injury)
    4. Hearing Loss or Decreased Visual Acuity
    5. Insomnia or other sleep deprivation
    6. Polypharmacy
    7. Hospitalization or post-surgery
    8. Multiple comorbid conditions
    9. Poor nutritional status
    10. Hepatic failure
    11. Chronic Renal Failure
    12. Poor nutritional status
  4. Precipitating Factors
    1. Infection
    2. Dehydration
    3. Electrolyte abnormalities
    4. Myocardial Infarction
    5. Arrhythmia
    6. Sleep Deprivation
    7. More than 3 medications added within 24 hours
    8. Psychoactive medications
  5. Criteria
    1. Rapid deterioration in all higher cortical functions
    2. Mental status fluctuates widely
    3. Short duration of symptoms (Hours to days)
    4. Disturbance in both Level of Consciousness and content
    5. Autonomic Instability (Abnormal vital signs)
  6. Signs
    1. Fluctuating levels of consciousness
      1. Inattention
      2. Perseveration
      3. Decreased alertness
      4. Disorientation
      5. Extremes of activity
        1. Somnolence to agitation
    2. Disorganized thought processes (delusions)
    3. Memory Impairment (especially short term)
    4. Perceptual disturbances
      1. Persecutory delusions are common
      2. Visual hallucinations rare except in organic cause
    5. Emotional lability
    6. Motor changes
      1. Myoclonus
      2. Asterixis
  7. Course
    1. Reversible in over 80% of cases
  8. Evaluation
    1. See Confusion Assessment Method
    2. See Altered Level of Consciousness (includes labs)
    3. Electroencephalogram
      1. Diffuse slow waves
  9. Differential Diagnosis
    1. See Altered Level of Consciousness Causes
    2. Dementia
    3. Psychosis
    4. Major Depression
  10. Management: Pharmacologic
    1. Precautions
      1. Antipsychotics are associated with increased mortality in the elderly
      2. Use only short-term and only when non-pharmacologic measures fail
      3. Limit to monitored settings
      4. See each agent for contraindications and adverse effects before use
    2. Agents: First-Line
      1. Haloperidol 0.5 to 1 mg orally twice daily
    3. Agents: Second-line
      1. Risperidone (Risperdal) 0.5 mg orally twice daily
      2. Olanzapine (Zyprexa) 2.5 to 5 mg orally twice daily
      3. Quetiapine (Seroquel) 25 mg orally twice daily
    4. Agents: Other
      1. Lorazepam 0.5 to 1 mg orally every 4 hours as needed
        1. Limit to Parkinson Disease, Drug Withdrawal, Neuroleptic Malignant Syndrome
  11. Prevention
    1. Optimize hydration and nutrition
    2. Early mobilization of patients
    3. Avoid sedatives for sleep (see Sleep Hygiene)
    4. Reduce restraints and catheters
    5. Reorient patient frequently (involve family presence)
    6. Correct vision and hearing
    7. Avoid psychoactive medications
      1. Anticholinergic Medications
      2. Benzodiazepines
      3. Narcotics
  12. References
    1. Cole (2004) Am J Geriatr Psychiatry 12(1):7
    2. Inouye (2006) N Engl J Med 354(11):1157
    3. Miller (2008) Am Fam Physician 78(11):1265

Delirium (C0011206)

Definition (MSH)A disorder characterized by CONFUSION; inattentiveness; disorientation; ILLUSIONS; HALLUCINATIONS; agitation; and in some instances autonomic nervous system overactivity. It may result from toxic/metabolic conditions or structural brain lesions. (From Adams et al., Principles of Neurology, 6th ed, pp411-2)
Definition (CSP)disorder characterized by confusion, inattentiveness, disorientation, illusions, hallucinations, agitation and in some instances autonomic nervous system overactivity; may result from toxic or metabolic conditions or structural brain lesions; condition may also be acute and reversible.
ConceptsMental or Behavioral Dysfunction (T048)
MSHD003693
EnglishABS - Acute brain syndrome, Acute brain syndrome, acute delirium, BRAIN SYNDROME ACUTE, Delirious, Delirium, SYNDROME BRAIN ACUTE
Spanishcon delirio, delira, delirio, sindrome cerebral agudo
Parent ConceptsDelirium (C0011206), Transient organic psychotic conditions (C0859649), Neurologic Manifestations (C0027854), Mental disorders (C0004936), Brain Diseases (C0006111), Psychotic Disorders (C0033975), BRAIN IRRITATION (C0549636), COGNITIVE/CORTICAL DISORDERS (C0549639), Confusion (C0009676), Delirium, Dementia, Amnestic, Cognitive Disorders (C0029227), Mental and Behavioral Signs and Symptoms (C0237088), cancer-related problem/condition (C0280950), Consciousness disturbance NOS (C0234428), [X]Delirium, not induced by alcohol and other psychoactive subs (C0494372), Duplicate concept (C1274013), Reason not stated concept (C1276325)
SourcesAOD, COSTAR, CSP, CST, DXP, LCH, MSH, MTH, NCI, NDFRT, PDQ, QMR, SCTSPA, SNOMEDCT
Derived from the NIH UMLS (Unified Medical Language System)



Navigation Tree