DELIRIUM A DISORDER THAT IS UNDERESTIMATED

The presentation talks about delirium which is misunderstanding

1. DELIRIUM V. KOUSHIK BATCH 2K19

2. DELIRIUM An acute organic brain disorder characterized by impairment in attention, concentration added by disturbance in thinking and perception

3. Incidence It has the highest incidence among organic mental disorders Most common among the elderly 2x more common in males Also a common surgical complication in older adults

4. ETIOLOGY Vascular – Hypertensive encephalopathy, ICH Infections – Encephalitis, Meningitis Neoplastic – Space occupying lesions Intoxication – Chronic intoxication or withdrawal of sedative hypnotic drugs Traumatic – Subdural and epidural hematoma Vitamin deficiency – eg , thiamine Endocrine and metabolic – Diabetic coma, uremia, CO poisoning Heavy metals – Pb, Mn, Hg Anoxia – Anemia, cardiac failure

5. PATHOPHYSIOLOGY – Theories

6. Presentation WHERE THE F AM I? W here – Disorientation T hought disorganization H allucinations E nergy changes F luctuating A cute M edical causes I ntoxicants

7. Clinical features Impairment of consciousness: clouding of consciousness ranging from drowsiness to stupor and coma. Impairment of attention: difficulty in shifting, focusing and sustaining attention. Perceptual disturbances: illusions and hallucinations, most often visual. Disturbance of cognition : impairment of abstract thinking and comprehension, impairment of recent and immediate memory, increased reaction time.

8. Psychomotor disturbances : hypo or hyper-activity, aimless groping or picking at the bed clothes (flocculation), enhanced startle reaction. Disturbance of sleep wake cycle : insomnia or in severe cases total sleep loss, daytime drowsiness, disturbing dreams or nightmares. Emotional disturbances : depression, anxiety, fear, irritability, euphoria, apathy.

9. DSM-5 Criteria It includes the presence of all of the following criteria: Disturbance in attention and awareness develops acutely and tends to fluctuate in severity. At least one additional disturbance in cognition. Disturbances are not better explained by preexisting dementia. Disturbances do not occur in the context of a severely reduced level of arousal or coma. Evidence of an underlying organic cause or causes.

10. TYPES OF DELIRIUM Hyperactive delirium – restlessness, agitation, aggression Hypoactive delirium – (most common) sleepy, withdrawn and quiet; difficult to recognize Mixed - Hypo-Hyperactive delirium

11. CAM – Confusion Assessment Method Several tools have been developed in a monitored setting to help detect delirium. One of the tools with the most widespread use is the  Confusion Assessment Method (CAM) The presence of delirium requires features 1 and 2 and either 3 or 4: 1. Acute change in mental status with a fluctuating course 2. Inattention (reduced ability to sustain attention and follow conversations) 3. Disorganized thinking (problems with memory, orientation, or language) 4. Altered level of consciousness (hypervigilance, drowsiness, or stupor) 

12. TREATMENT Treat the underlying cause Creating a healing and calming environment If severe symptoms - Antipsychotics