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.

•Accidental or intentional poisoning•Elderly clients•Recent major surgery•Pre existing cognitive dysfunction•Multiple drug therapy, especially polypharmacy of dose•High doses of hypnotics

RISK FACTORS

Final common neural pathway( Neuroanatomical and neurotransmitter systems)

 Causes

Diverse aetiologies of delirium Causes  

Implication of right side brain region  Causes

Reduced cholinergic function 

CausesExcess release of dopamine

Causes

Increased serotonergic activity  

Leads to

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/tidA 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.