Delirium: Difference between revisions
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== Clinical Features == | == Clinical Features == | ||
*Main cognitive impairment is that of inattention (vs memory in dementia) | |||
*Generally develops over hours to days | |||
*Symptoms are classically described as fluctuating throughout the day (ie may appear normal in between episodes) | |||
===ED Confusion Assessment Method<ref>Inouye SK, van Dyck CH, Alessi CA, et al. Clarifying confusion: the confusion assessment method. A new method for detection of delirium. Ann Intern Med 1990; 113:941.</ref>=== | ===ED Confusion Assessment Method<ref>Inouye SK, van Dyck CH, Alessi CA, et al. Clarifying confusion: the confusion assessment method. A new method for detection of delirium. Ann Intern Med 1990; 113:941.</ref>=== | ||
*Acute onset of mental status changes and/or fluctuating course | |||
*Anattention | |||
*Disorganized thinking | |||
*Altered level of consciousness | |||
A patient must possess both features 1 and 2 AND either 3 or 4 to meet delirium criteria | A patient must possess both features 1 and 2 AND either 3 or 4 to meet delirium criteria | ||
== Differential Diagnosis== | == Differential Diagnosis== | ||
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{{Psych DDX}} | {{Psych DDX}} | ||
== Diagnosis== | |||
Main goal is to find the underlying cause. | |||
*CBC (eg elevated WBC) | |||
*U/E/Cr (eg electrolyte derangements) | |||
*LFTs (eg hepatobiliary infection) | |||
*Urine analysis (eg UTI) | |||
*CXR (eg pneumonia) | |||
*?Utox | |||
*?CT/LP | |||
== Treatment == | == Treatment == | ||
*Treat underlying cause | *Treat underlying cause | ||
*Antipsychotics (eg haloperidol, risperidone) may be useful for hyperactive delirium with psychotic features | *Antipsychotics (eg haloperidol, risperidone) may be useful for hyperactive delirium with psychotic features | ||
==Disposition== | |||
*Admission | |||
==See Also== | ==See Also== | ||
Revision as of 02:47, 2 December 2015
Background
Delirium vs. dementia vs. psych
Clinical Features
- Main cognitive impairment is that of inattention (vs memory in dementia)
- Generally develops over hours to days
- Symptoms are classically described as fluctuating throughout the day (ie may appear normal in between episodes)
ED Confusion Assessment Method[1]
- Acute onset of mental status changes and/or fluctuating course
- Anattention
- Disorganized thinking
- Altered level of consciousness
A patient must possess both features 1 and 2 AND either 3 or 4 to meet delirium criteria
Differential Diagnosis
- A
- Alcohol
- E
- Electrolyte Abnormalities
- Encephalopathy (hepatic, hypertensive)
- I
- Insulin (hypoglycemia)
- O
- Opiates
- U
- Uremia
- T
- Trauma
- Toxic Exposure
- Thyrotoxicosis
- I
- Infection
- P
- Psych
- S
General Psychiatric
- Organic causes
- Psychiatric causes
Diagnosis
Main goal is to find the underlying cause.
- CBC (eg elevated WBC)
- U/E/Cr (eg electrolyte derangements)
- LFTs (eg hepatobiliary infection)
- Urine analysis (eg UTI)
- CXR (eg pneumonia)
- ?Utox
- ?CT/LP
Treatment
- Treat underlying cause
- Antipsychotics (eg haloperidol, risperidone) may be useful for hyperactive delirium with psychotic features
Disposition
- Admission
See Also
References
- ↑ Inouye SK, van Dyck CH, Alessi CA, et al. Clarifying confusion: the confusion assessment method. A new method for detection of delirium. Ann Intern Med 1990; 113:941.