Delirium/Deliria. All answers are from APA Practice Guideline AJP May 1999 Supplement, DSM-IV-TR, and Delirium Guideline Watch, at www.psych.org . As of 28Jul06. Next revision due May 9, 2007. Delirium - criteria . Q. Basic criteria of “delirium”?. Delirium - criteria. Ans.
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Delirium/Deliria All answers are from APA Practice Guideline AJP May 1999 Supplement, DSM-IV-TR, and Delirium Guideline Watch, at www.psych.org. As of 28Jul06. Next revision due May 9, 2007
Delirium - criteria Q. Basic criteria of “delirium”?
Delirium - criteria Ans. • Disturbance of consciousness • Disturbance of cognition • Disturbance develops over a period of hours to days • Disturbance fluctuates during the course of a day • Evidence that disturbance is result physiological consequences of a general medical condition, a substance or withdrawal from a substance
Differ from dementia Q. How does dementia differ from delirium?
Diff from dementia Ans. While they both have memory deficits, pts with dementia are/have: -- alert -- no consciousness deficits -- no arousal deficits -- slow onset of condition -- little change over the course of a day.
Communications Q. What four communication psychopathologies are common in delirium?
Communications Ans. 1] aphasia 2] dysarthria 3] dysnomia 4] dysgraphia
memory Q. Which memory impairment is most common?
memory Ans. Recent.
Neurological abnormalities in Li intoxication Q. Neurological abnormalities in Li intoxication include?
Neurological abnormalities inLi intoxication Ans. 1] cerebella signs 2] myoclonus 3] hyper-reflexia
Orientation Q. Which disorientation is rare?
Orientation Ans. To self.
EEG Q. EEG findings in delirium?
EEG Ans. Usually generalized slowing, but there is a major exception asked for in the next slide.
EEG - exception Q. What is the exception to generalized slowing?
EEG - exception Ans. Delirium associated with alcohol and other sedatives where one sees generalized fast activity
Age prevalence Q. Which age groups is delirium common?
Prevalence – age groups Ans. Children and the elderly.
Elderly - gender Q. Which gender more frequently suffers from delirium?
Elderly - gender Ans. Men.
Prevalence - hospitals Q. Prevalence of delirium on the medical and surgical wards of hospitals?
Prevalence - hospitals Ans. 10 – 30%.
Terminal illness Q. Percentage of terminally ill who become delirious?
Terminally ill Ans. Up to 80%.
Mortality Q. Mortality of elderly who are hospitalized and develop delirium?
Mortality Ans. Up to 20-75%. [Obviously, this is too broad to easily be the answered, but this range does give one a sense of the correct answer as one weighs the other factors in the examiner’s question.]
Delirium differential Q. What are the four major categories of illnesses/disorders that are associated with delirium?
Delirium differential Ans. • General medical conditions. • Substances intoxication or withdrawal • Medications. • Toxic exposures
Hypoglycemia Q. Pt delirious and hypoglycemia suspected. What is the treatment?
Hypoglycemia Ans. • Finger stick • Thiamine 100 mg IV before glucose • 50 ml IV of 50% glucose solution
Hypoxia Q. Delirious and hypoxia suggestive, what to do?
Hypoxia Ans. O2
Hyperthermia Q. Delirious and temp above 105 F, what to do?
Hyperthermia Ans. Rapid cooling.
Hypertensive Q. Delirious and hypertensive with BP of 160/150, what to do?
Hypertension Ans. Guideline only says “prompt antihypertensive treatment.” Merck Manual, p 618, lists nine possible meds to considering using -- after getting the pt to an ICU with goal of decreasing BP 25%/hour.
Wernicke’s Q. Treatment of Wernicke’s?
Wernicke’s Ans. 100 mg thiamine IV, followed by same daily p.o.
Malnutrition Q. Delirium associated with malnutrition should be given?
Malnutrition Ans. B vitamins.
Sedative/alcohol withdrawal Q. Management of sedative/alcohol withdrawal delirium?
Sedative/alcohol withdrawal Ans. 1] Benzodiazepines 2] thiamine IV 3] glucose IV 4] magnesium 5] phosphates, and 6] folate and other B vitamins
Anticholinergic Q. Delirious from anticholinergic meds. What to do?
Anticholinergic Ans. • Withdraw meds. • Physostigmine
Physostigmine Q. What is action of physostigmine?
physostigmine Ans. Cholinesterase inhibitor.
Physostigmine side effects Q. Side effects of physostigmine?
Physostigmine – side effects Ans. • Bradycardia • Nausea and vomiting • Salivation • Increased gastric acid. • Seizures
Physostigmine - doses Q. Doses of physostigmine?