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