Delirium<br />by:<br />AdiliaAdris<br />
Definition <br />An acute organic reaction (mental state) with the major disturbance,  clouding of consciousness, concurre...
Epidemiology<br />affects 15 to 50% of hospitalized people aged 70 or older.<br />may occur at any age but is more common ...
Etiology <br />Systemic infection<br />Eg: any infection esp with high fever like malaria<br />Metabolic disturbances<br /...
Intracranial causes<br />Trauma<br />Tumor<br />Abcess<br />Epilepsy<br />Subarachnoid haemorrhage<br />Drug intoxication<...
Subcategories  ( DSM-IV)<br />
Symptoms (Key Features) <br />Altered consciousness with hyperarousal OR        hypoarousal  with agitation or apathy<br /...
8<br />Neurological symptoms<br />Incoordination<br />Dysphasia<br />Tremor<br />Asterixis<br />Ataxia<br />Apraxia<br />
Diagnostic Criteria for Delirium<br />
Delirium due to a General Medical Condition<br />Disturbances of consciousness<br />A change in cognition or the developme...
Substance intoxication delirium<br />Disturbance of consciousness with reduced ability  to focus, sustain, or shift attent...
Substance withdrawal delirium<br />Disturbance of consciousness with reduced ability  to focus, sustain, or shift attentio...
Delirium due to multiple etologies<br />Disturbance of consciousness with reduced ability  to focus, sustain, or shift att...
Delirium Not Otherwise Specified <br />This category should be used to diagnose a delirium that does not Meet the criteria...
15<br />Patophysiology<br />Delirium is a result of the diffuse damage from the nerve tissue metabolism<br />This can be s...
16<br />Differential Diagnosis<br />Dementia <br />Schizophrenia<br />Psychosis<br />Depression<br />
DELIRIUM vs DEMENTIA?<br />
18<br />Therapy<br />Treatment of underlying cause<br />Medical care<br />Drugs to control agitated and agressivebehaviour...
Complications<br />Loss of ability to function or care for self<br />Loss of ability to interact<br />Progression to stupo...
Prognosis<br />often lasts only about 1 week, although it may take several weeks for mental function to return to normal<b...
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Delirium

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Delirium

  1. 1. Delirium<br />by:<br />AdiliaAdris<br />
  2. 2. Definition <br />An acute organic reaction (mental state) with the major disturbance, clouding of consciousness, concurrence with disturbances of attention, orientation, memory, perception, delusion, restlessness and agitation.<br />Short term confusion ( acute confusional state) and changes in levels of consciousness<br />rujukan<br />
  3. 3. Epidemiology<br />affects 15 to 50% of hospitalized people aged 70 or older.<br />may occur at any age but is more common among older people. <br />When delirium occurs in younger people, it is usually due to drug use or a life-threatening disorder.<br />
  4. 4. Etiology <br />Systemic infection<br />Eg: any infection esp with high fever like malaria<br />Metabolic disturbances<br />eg: hepatic failure, renal failure, dehydration, hypoxia, electrolyte imbalance<br />Vitamin deficiency<br />Eg: B1, B12<br />Endocrine disease<br />Hypothyroidism<br />Cushing’s syndrome<br />
  5. 5. Intracranial causes<br />Trauma<br />Tumor<br />Abcess<br />Epilepsy<br />Subarachnoid haemorrhage<br />Drug intoxication<br />Anticonvulsants<br />Antimuscarinics<br />Anxiolytics<br />Tricyclic antidepressant<br />Drug/ alcohol withdrawal<br />Postoperative states<br />Terminal illness<br />
  6. 6. Subcategories ( DSM-IV)<br />
  7. 7. Symptoms (Key Features) <br />Altered consciousness with hyperarousal OR hypoarousal with agitation or apathy<br />Memory impairment<br />Disorientation<br />Illogical speech<br />Severe emotional lability<br /> perceptual disturbances -Hallucinations (auditory/visual/ Tactile)<br />Fragmented sleep (sleep-wake cycle disturbance)<br />Fluctuating levels of consciousness<br />
  8. 8. 8<br />Neurological symptoms<br />Incoordination<br />Dysphasia<br />Tremor<br />Asterixis<br />Ataxia<br />Apraxia<br />
  9. 9. Diagnostic Criteria for Delirium<br />
  10. 10. Delirium due to a General Medical Condition<br />Disturbances of consciousness<br />A change in cognition or the development of a perceptual disturbance that is not better accouted for by preexisting, established, or evolving dementia.<br />The disturbance develops over a short period of time and tends to fluctuate during the course of the day<br />There is evidance from the history , physical examination , or laboratory findings that the disturbance is caused by the direct physiological consequences of a general medical condition.<br />
  11. 11. Substance intoxication delirium<br />Disturbance of consciousness with reduced ability to focus, sustain, or shift attention.<br />A change in cognition or the development of a perceptual disturbance that is not better accounted for by preexisting, established, or evolving dementia.<br />The disturbance develops over a short period of time and tends to fluctuate during the course of the day<br />There is evidence from the history , physical examination , or laboratory findings of either (1) or (2)<br />The symptoms in criteria A and B developed during substance intoxication<br />Medication used is etiologically related to the disturbance<br />
  12. 12. Substance withdrawal delirium<br />Disturbance of consciousness with reduced ability to focus, sustain, or shift attention.<br />A change in cognition or the development of a perceptual disturbance that is not better accounted for by preexisting, established, or evolving dementia.<br />The disturbance develops over a short period of time and tends to fluctuate during the course of the day<br />There is evidence from the history , physical examination , or laboratory findings that the symptoms in criteria A and B developed during , or shortly after , a withdrawal syndrome<br />
  13. 13. Delirium due to multiple etologies<br />Disturbance of consciousness with reduced ability to focus, sustain, or shift attention.<br />A change in cognition or the development of a perceptual disturbance that is not better accounted for by preexisting, established, or evolving dementia.<br />The disturbance develops over a short period of time and tends to fluctuate during the course of the day<br />There is evidence from the history , physical examination , or laboratory findings that the delirium has ore than one etiology <br />
  14. 14. Delirium Not Otherwise Specified <br />This category should be used to diagnose a delirium that does not Meet the criteria for any of the specific types of delirium described in this section.<br />
  15. 15. 15<br />Patophysiology<br />Delirium is a result of the diffuse damage from the nerve tissue metabolism<br />This can be seen from :<br />EEG study<br />generalized slowing activity of EEG<br />slowing of the low amplitudo<br />Blood flow in the brain<br /> reduce usage of O2<br />
  16. 16. 16<br />Differential Diagnosis<br />Dementia <br />Schizophrenia<br />Psychosis<br />Depression<br />
  17. 17. DELIRIUM vs DEMENTIA?<br />
  18. 18. 18<br />Therapy<br />Treatment of underlying cause<br />Medical care<br />Drugs to control agitated and agressivebehaviour<br />Antidepresssants (fluoxetine, citalopram)<br />Dopamine blockers (haloperidol 5-10 mg/IM)<br />Sedatives (clonazepam or diazepam)<br />Thiamine<br />Symptomatic therapy<br />Antipsychotic :<br />Benzodiazepine : diazepam 10 mg/IM<br />
  19. 19. Complications<br />Loss of ability to function or care for self<br />Loss of ability to interact<br />Progression to stupor or coma<br />Side effects of medications used to treat the disorder<br />
  20. 20. Prognosis<br />often lasts only about 1 week, although it may take several weeks for mental function to return to normal<br />Full recovery is common.<br />
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