Delirium

Delirium is also known as an Acute Confusional State. It presents with an acute and fluctuating course of changes in cognitive function, perception, physical function and social behaviour:

• Disorientation

• Hallucinations

• Inattention

• Memory problems

• Change in mood or personality

• Disturbed sleep

• Hypoactivity

• Reversed sleep-wake cycle

Risk factors - Elderly, Dementia, Severe illness, Hip fracture

Causes - Infection, Pain, Post-surgery, Metabolic, Medication, Neurological, Environment

Types - Hyperactive, Mixed, Hypoactive

• Hypoactive is the most common type, but is

  easily mistaken for depression/dementia

Investigations:

• Cognitive screening tests - Short-CAM, 4AT, or DSM-5

• Delirium screen - Glucose, Calcium, Vitamin B12, Folate, TSH, MSU, CTH

• Infection screen - Urine dip, CXR, Blood culture

Management:

• Treat underlying cause

• Small doses of haloperidol or olanzapine may be considered