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