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DELIRIUM

Delirium is an acute and


debilitating decline in attention-focus,
perception, and cognition that
produces an altered form of semi-
consciousness. It is a systemic
syndrome caused by a chemical or
disease-process which is disrupting the
neurons of the cerebral cortex.
Delirium itself is not a disease, but
rather a clinical syndrome (a set of
symptoms), which result from an
underlying disease or new problem
with mentation. Like its components
(inability to focus attention, confusion
and various impairments in awareness
and temporal and spatial orientation),
delirium is simply the common
symptomatic manifestation of early
brain or mental dysfunction.
Without careful assessment, delirium can
easily be confused with a number of
psychiatric disorders because many of the
signs and symptoms are conditions present
in dementia, depression, and psychosis.
Delirium is probably the single most
common acute disorder affecting adults in
general hospitals. It affects 10-20% of all
hospitalized adults, and 30-40% of elderly
hospitalized patients and up to 80% of ICU
patients.
RISK FACTORS
•Accidental or
intentional poisoning
•Elderly clients
•Recent major surgery
•Pre existing cognitive
dysfunction
•Multiple drug
therapy, especially
polypharmacy of dose
•High doses of
hypnotics
Final common neural pathway
( Neuroanatomical and neurotransmitter systems)
 
Causes
     Diverse aetiologies of delirium
 Causes  

   Implication of right side brain region  
Causes
Reduced cholinergic function
 
Causes
Excess release of dopamine
Causes

Increased serotonergic activity
  to
Leads

DELIRIUM
 
Manifestations
• Nervous System
- Cognitive Impairment
- Disturbances of Attention
- Reduced level of
Consciousness
- Disorganized sleep-wake
cycle
• Musculoskeletal System
-Increased or decreased
psychomotor
Diagnostic Tests:
• CBC
• sedimentation rate
• BUN
• blood alcohol level
• urinalysis
• urine drug screen
• CT scan of the brain and EEG
• Arterial blood gases
• ECG
• Thyroid tests
• MRI
Delirium is a clinical diagnosis. Diagnosis is based
on observed changes in mental status that are
related to some underlying medical disturbance.
Delirium is diagnosed through the medical history
and recognition of symptoms during mental status
examination. The most important part of diagnosis
is determining the cause of the delirium.
Several formal instruments have been
developed to help diagnose and monitor
the clinical course of delirium: the
Clinical Assessment of Confusion; the
Delirium Symptom Inventory; and the
Delirium Rating Scale. These
instruments are generally used for
research. Standard psychiatric and
medical examinations are usually
sufficient to diagnose and evaluate
delirium.
Medications

Neuroleptics
• Haloperidol (Haldol) Adult Moderate symptomatology: 0.5-2 
mg PO bid/tid
A  butyrophenone  high-potency  antipsychotic.  One  of  most 
effective  antipsychotics  for  delirium.  High-potency  antipsychotic 
medications  also  cause  less  sedation  than  phenothiazines  and 
reduce risks of exacerbating delirium.

• Risperidone (Risperdal) Adult 0.5-2 mg PO qd or bid


  A  newer  antipsychotic  with  fewer  extrapyramidal  adverse 
effects  than  Haldol.  Binds  to  dopamine  D2-receptor  with  20 
times  lower  affinity  than  for  5-HT2-receptor.  Improves  negative 
symptoms  of  psychoses  and  reduces  incidence  of  adverse 
extrapyramidal effects.
•Lorazepam (Ativan) Adult 0.5-2 mg PO/IV/IM;
frequent repeat dosing (q2-4h) may be needed
Preferable because it is short acting and has
no active metabolites. In addition, can be used in
both IM and IV forms. When patient needs to be
sedated for longer than 24 h, this medication is
excellent. Commonly used prophylactically to
prevent delirium tremens.