Delirium
glasses; hearing aids
Make sure the pt has his/her __________ on and _________ ______ in, as this might account for their decline in consciousness
Medications
Most common cause of delirium in the elderly
Delirium
Most common psychiatric diagnosis
attention; awareness
The DSM further defines delirium as a reduced ability to maintain and direct _______ and reduced _________ and orientation to environment
ACH; dopamine
The elderly also have a decline in these 2 neurotransmitters, that can result in an alteration of the effects of certain medications
Neuronal mass
The elderly suffer from a decrease in _________ ____________ due to age that leads to heightened sensitivity to drugs in the brain
Generalized slowing
The most common EEG finding in delirium
Dementia
Among brain injured/diseased pt's, those with _________ are at particular risk of delirium
Heart
Among post-op pt's, those recovering from _______ surgery are particularly at risk for delirium
Urinary tract
A common etiology of delirium in elderly nursing home pt's (not medications) is a __________ infection
Cerebral metabolic activity (slowing of background brainwave activity)
All of the insults that cause delirium have the final common pathway of a widespread alteration in ________ _________ _________
Sedating (BDZ, alcohol, barbituates)
Although drug withdrawal overall is a large risk factor for delirium, withdrawing ____________ drugs puts you at the highest risk (verb to describe what drugs do)
Cognition; mood
Although it's not the main characteristic, pt's with delirium may also have disturbances in __________ or _________
25;75
Between ______%-________% of pt's die as a result of delirium, the highest of any psych dx
fast; consciousness; psychotic
Delirium is characterized by a (fast/insidious) change in level of (consciousness/cognition) and mood that may have ________ symptoms
cognition; consciousness
Dementia, conversely, has a decline in __________ but clear ________
mood; psychotic
Depression is characterized by ________ changes and possible ________ symptoms but does not include changes in cognition and has normal consciousness
Lean muscle mass; fat
Elderly have a decrease in ________ ___________ _________ that can increase the serum concentrations of the drug. Additionally, they have an increase in __________ leading to a wider distribution and slower clearance of lipid-soluble drugs
GFR (glomerular filtration rate)
Elderly pt's also have decreased ________ due to renal disease which leads to decreased renal clearance and therefore a long drug half-life
plasma-binding proteins
Elderly pt's with malnutrition or chronic inflammatory diseases can lead to decreased synthesis of ________-________ _________ that leads to increased bioavailibility to the brain
Fly Ry, The Suty Guy!
ID this geography bee champion
acute; insidious
In terms of time course, delirium is ________ while dementia is _________ (kind of read my mind-y but you'll get it the second time)
Infections; Withdrawal; Acute (metabolic condition); Trauma; CNS (disease); Hypoxia; Deficiencies; Environmental; Acute (vascular); Toxins (/drugs); Heavy (metals)
List the insults that can cause delirium as spelled out by the mnemonic I WATCH DEATH (1 word for each)
Animals (rats, insects, snakes)
Often deliriuous pt's will claim to feel/see ________ crawling on them (general term)
Major depressive disorder; schizophrenia
On EEG, delirium can be distinguished from other psych illnesses like _________ ______ ______ and _________ which do not show changes on EEG
Polypharmacy
Term for the fact that the elderly are often on multiple drugs. This leads to a cumulative side effect, where one med may have minimal side effects but when combined with the other ones, it becomes substantial
Neurotransmitters
Pt's that already a deficiency in key _____________ are at risk for being delirious
burns
Pt's with severe _________ are at high risk for delirium presumably due to systemic alterations in metabolism
GABA
Sedatives can cause delirium via the activation of the __________ pathways in the brain. This suppresses neuronal transmission
Fever, tremors, (hearing) voices
These 3 symptoms are common for alcohol withdrawal (DT's)
Elderly
This age group is more likely to suffer from delirium
Mini-Mental Examination
This exam is often very helpful in determining if a pt is delirious
False
True/False: Absence of EEG findings rules out delirium
hepatic metabolism
With regards to breakdown, the elderly have a decreased ___________ ____________ that leads to an increased half life and delayed appearance of active intermediate metabolites
Schizophrenia
_____________ has psychotic symptoms, but no or mild decline in consciousness and generally normal cognition and mood
longer; worse
pt's with delirium have _______ hospital stays and a _________ recovery time