Upload
curtis-holmes
View
217
Download
1
Embed Size (px)
Citation preview
Seyed Kazem Malakouti, MD,Iran University of Medical Sciences
Delirium
Seyed Kazem Malakouti, MD,Iran University of Medical Sciences
DSM-IV
• A. attention disturbance• B. onset in short period of time• C. additional cognitive dis./ or perception• Due to substance abuse/withdrawal• Due to physical disorder• Acute, hours-days• Chronic, weeks-months• Hyperactive/hypoactive
Seyed Kazem Malakouti, MD,Iran University of Medical Sciences
EPIDEMIOLOGY
• 14-24 percent at the time of admission• 6-56 percent in hospital• More prevalent after– Hip fracture– ICU
Seyed Kazem Malakouti, MD,Iran University of Medical Sciences
• Clinicians failed to detect up to 70%• Mortality rate at hospital, 50%• One year after hospital, 35%
Seyed Kazem Malakouti, MD,Iran University of Medical Sciences
features
• Acute onset and fluctuating course• Inattention• Disorganized thinking• Altered level of consciousness
Seyed Kazem Malakouti, MD,Iran University of Medical Sciences
Seyed Kazem Malakouti, MD,Iran University of Medical Sciences
Seyed Kazem Malakouti, MD,Iran University of Medical Sciences
Seyed Kazem Malakouti, MD,Iran University of Medical Sciences
Delerium feature• insidiously over weeks to months• fluctuating course• difficulty focusing, maintaining, and shifting• attention or concentration• perseverate with an answer to a previous question• disorganization of thought and altered level• of consciousness• lethargy, with a reduced awareness• disorientation (more commonly• to time and place than to self• hallucinations, • paranoid delusions, • sleep–wake cycle disruption.
Seyed Kazem Malakouti, MD,Iran University of Medical Sciences
Physical examinationfindings Clinical implication
Bradycardia Hypothyroidism
ICP rise
Tachycardia Hyperthyroidism
Infection
Heart failure
Fever Sepsis
Thyrodi storm
Vasculitis
Seyed Kazem Malakouti, MD,Iran University of Medical Sciences
Findings Clinicl implication
Hypotension Shock
Hypothroidiesm
addison disease
Hypertension Encephalopathy
Brain mass
Tachypnea Diabetes
Pnemonia
Cardiac failure
Fever
Carotid bruits TIA
Nuchal regidity Meningities
Papilledema Tumor
Hypertensive encephalopathy
Seyed Kazem Malakouti, MD,Iran University of Medical Sciences
Findings Clinical impaliction
Cardiomegaly Heart failure
Hypertensive disease
Liver enlarmenent Cirrhosis
Babinski Mass lesion
Cerebrovascular disease
Dementia
Weakness in lateral gaze ICP rise
Tongue & cheeck laceration Seizure
Breath keton Diabete
alcohol
Seyed Kazem Malakouti, MD,Iran University of Medical Sciences
Seyed Kazem Malakouti, MD,Iran University of Medical Sciences
Seyed Kazem Malakouti, MD,Iran University of Medical Sciences
Seyed Kazem Malakouti, MD,Iran University of Medical Sciences
Seyed Kazem Malakouti, MD,Iran University of Medical Sciences