- What is the definition of acute confusional state (delirium)?
- A syndrome characterized by disturbances in attention, awareness, and cognition, with acute onset and fluctuating course.
- 2. What are the key features of delirium?
- Disturbed attention, disorganized thinking, altered level of consciousness, perceptual disturbances (e.g., hallucinations), and fluctuating symptoms over the day.
- 3. What are the common causes of delirium?
- Infections (e.g., UTI, pneumonia), metabolic derangements (e.g., hyponatremia, uremia), medications (e.g., anticholinergics, opioids), withdrawal states (e.g., alcohol, benzodiazepines), and structural brain lesions (e.g., tumors, strokes).
- 4. How is delirium diagnosed?
- Clinical diagnosis based on DSM-5 or ICD-11 criteria, with exclusion of other causes (e.g., dementia, psychosis).
- 5. What is the initial management of delirium?
- Identify and treat the underlying cause (e.g., antibiotics for infection, fluid correction for dehydration).
- Non-pharmacological interventions: reorientation, low-stimulus environment, sleep-wake cycle regulation.
- 6. When is pharmacologic treatment indicated for delirium?
- For severe agitation or distress, short-term use of antipsychotics (e.g., haloperidol, quetiapine) or benzodiazepines (e.g., lorazepam) if delirium is due to withdrawal.
- 7. How does delirium differ from dementia?
- Delirium has acute onset, fluctuating course, and reversible causes; dementia is chronic, progressive, and irreversible.
- 8. What are the risk factors for delirium?
- Advanced age, pre-existing cognitive impairment, severe illness, polypharmacy, and sensory impairments (e.g., vision/hearing loss).
- 9. How can delirium be prevented in hospitalized patients?
- Multicomponent interventions: orientation, cognitive stimulation, sleep promotion, early mobilization, and minimizing sedatives.
- 10. What is the prognosis of delirium?
- Often reversible if the underlying cause is treated, but may lead to prolonged cognitive impairment or functional decline in vulnerable patients.