DELIRIUM Mr.Abdulaziz R. Alanzi

Medical Student, Al-Imam University

Riyadh – Saudi Arabia

Delirium is an acute, fluctuating disturbance of consciousness, associated with a change in cognition or the development of perceptual disturbances

Definition

Clinically delirium can be divided into the following threecategories:

i. Hyperactive Delirium (30%). Patients are agitated and hyper alert with repetitive behaviours, wandering, hallucinations and aggression. Although recognised earlier, there is association with increased use of benzodiazepines, over sedation, use ofrestraints and falls.

ii. Hypoactive Delirium (25%). Patients are quiet and withdrawn which is often missed on a busy medical ward leading to increased length of stay, increased and more severe complications.

iii. Mixed Delirium. Fluctuating pattern seen in 45% of cases.

Classification

Causes & RFs

Causes

Substance induced conditions

General Medical Conditions

InfectionMetabolic Disorders

hepatic or renal failureseizure

Head injury

Drug intoxicationdrug withdrawal

Pathophysiology

Clinical Features

Diagnosis Approach

History• Information from a collateral source such as a spouse or

another family member.• Most important things to ask :

1. the patient's baseline cognitive function.

2. the time course of the present illness.

3. current medications.

Deference between dementia and delirium

Haloperidol

• Class: Antipsychotic and neuroleptic

• Haloperidol is a frequently used tranquilizer.

• MOA: Haloperidol is a major tranquilizer of the butyrophenone class that has proved effective in management of acute psychotic episodes. It has pharmacological properties similar to those of the phenothiazine class of drugs (e.g., Thorazine). Haloperidol appears to block dopamine receptors in the brain associated with mood and behavior. However, its precise mechanism of action Is not clearly understood. Haloperidol has weak anticholinergic properties.

• Half-Life: 3-35 hours

• Indications: Haloperidol is used in acute psychotic episodes.

• Contraindications: Haloperidol should not be administered in cases in which other drugs, especially sedatives, may be present. It should not be used in the management of dysphoira caused by Talwin because it may promote sedation and anesthesia.

• SE: Extrapyramidal Symptoms (EPS), Insomnia, Restlessness, Drowsiness, Tachycardia, Seizures, Respiratory Depression, Dry Mouth, Constipation, Hypotension

THANK YOU

d0pa@hotmail.com@AbdulazizEnazi

http://imamu.academia.edu/AbdulazizAlanzi