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Delirium

Delirium Select Specialty Hospitals Denver William A Locy, Ed.D. Rocky Mountain Rehabilitation Medicine, P.C. Delirium

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Delirium

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  1. Delirium Select Specialty Hospitals Denver William A Locy, Ed.D. Rocky Mountain Rehabilitation Medicine, P.C.

  2. Delirium • DSM-IV definition: “The essential feature of delirium is disturbance in consciousness that is accompanied by a change in cognition that cannot be better accounted for by a preexisting or evolving dementia.”

  3. Delirium • Acute confusional state • Acute brain syndrome • Metabolic encephalopathy • Toxic psychosis • Acute brain failure

  4. Delirium • 10 to 15% general surgical wards • 15 to 25% general medical wards • Geriatric population: 30 to 40% hospitalized patients over 65 have experienced delirium • 30% patients in surgical and cardiac intensive care units

  5. Delirium • 40 to 50% of patients recovering from surgery from hip fractures • 30 to 40% hospitalized AIDS • 38.5% following cardiac surgery

  6. Delirium • Pathophysiology • Susceptible areas: reticular activating system; hippocampus; cortex • Cerebellum is relatively spared

  7. Delirium • Excessive dopamine release (hypoxia) • Cholinergic overactivity in neurons in the RAS, cortex, cortex • Neuronal hyperpolarization

  8. Delirium • Rapid development • A few hours to days • Fluctuating presentation (serial examinations) • Disturbances range from mild to severe and global

  9. Delirium • Disturbance in sleep wake cycle (early symptom) • Perceptual disturbance (IV tubing a snake) to hallucinations (most common visual but any sensory modality) • Attention and concentration

  10. Delirium • Memory • Restlessness agitation • Frank delusions or paranoia

  11. Delirium • Differential diagnosis • Dementia • Depression • Psychotic disorders (schizophrenia) • Substance intoxication

  12. Delirium • Geriatric population is more susceptible to delirium • Patients with any brain insult (TBI, Hypoxia, CVA, Tumor) are more susceptible to delirium

  13. Delirium • Rapid diagnosis • Medical management (e.g. resolve infection, change in respiratory status, drug toxicity, fluid/electrolyte imbalance) • Pertinent laboratory and radiologic tests • Collateral information (premorbid status) • Thorough review of medications

  14. Delirium • Intervention resolve the underlying causal factors • Prolonged delirium may require medication intervention • Benzodiazapines with few exceptions (alcohol/sedative hypnotics withdrawal) is used as adjunctive in low doses of fast metabolizing medications) • Antipsychotics

  15. Delirium • Environmental interventions • Routine • Assist in the regulation of sleep wake cycle • Manage stimulation

  16. Delirium • Nursing education • Communication • Psychiatric • Neuropsychological

  17. Delirium • Outcomes • Increased mortality 3 month 25% 1 year as high as 50% • Increased patient family suffering • Increased cost

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