1. Delirium by: AdiliaAdris

2. Definition 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. Short term confusion ( acute confusional state) and changes in levels of consciousness rujukan

3. Epidemiology affects 15 to 50% of hospitalized people aged 70 or older. may occur at any age but is more common among older people. When delirium occurs in younger people, it is usually due to drug use or a life-threatening disorder.

4. Etiology Systemic infection Eg: any infection esp with high fever like malaria Metabolic disturbances eg: hepatic failure, renal failure, dehydration, hypoxia, electrolyte imbalance Vitamin deficiency Eg: B1, B12 Endocrine disease Hypothyroidism Cushing’s syndrome

5. Intracranial causes Trauma Tumor Abcess Epilepsy Subarachnoid haemorrhage Drug intoxication Anticonvulsants Antimuscarinics Anxiolytics Tricyclic antidepressant Drug/ alcohol withdrawal Postoperative states Terminal illness

6. Subcategories ( DSM-IV)

7. Symptoms (Key Features) Altered consciousness with hyperarousal OR hypoarousal with agitation or apathy Memory impairment Disorientation Illogical speech Severe emotional lability perceptual disturbances -Hallucinations (auditory/visual/ Tactile) Fragmented sleep (sleep-wake cycle disturbance) Fluctuating levels of consciousness

8. 8 Neurological symptoms Incoordination Dysphasia Tremor Asterixis Ataxia Apraxia

9. Diagnostic Criteria for Delirium

10. Delirium due to a General Medical Condition Disturbances of consciousness A change in cognition or the development of a perceptual disturbance that is not better accouted for by preexisting, established, or evolving dementia. The disturbance develops over a short period of time and tends to fluctuate during the course of the day 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.

11. Substance intoxication delirium Disturbance of consciousness with reduced ability to focus, sustain, or shift attention. A change in cognition or the development of a perceptual disturbance that is not better accounted for by preexisting, established, or evolving dementia. The disturbance develops over a short period of time and tends to fluctuate during the course of the day There is evidence from the history , physical examination , or laboratory findings of either (1) or (2) The symptoms in criteria A and B developed during substance intoxication Medication used is etiologically related to the disturbance

12. Substance withdrawal delirium Disturbance of consciousness with reduced ability to focus, sustain, or shift attention. A change in cognition or the development of a perceptual disturbance that is not better accounted for by preexisting, established, or evolving dementia. The disturbance develops over a short period of time and tends to fluctuate during the course of the day 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

13. Delirium due to multiple etologies Disturbance of consciousness with reduced ability to focus, sustain, or shift attention. A change in cognition or the development of a perceptual disturbance that is not better accounted for by preexisting, established, or evolving dementia. The disturbance develops over a short period of time and tends to fluctuate during the course of the day There is evidence from the history , physical examination , or laboratory findings that the delirium has ore than one etiology

14. Delirium Not Otherwise Specified 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.

15. 15 Patophysiology Delirium is a result of the diffuse damage from the nerve tissue metabolism This can be seen from : EEG study generalized slowing activity of EEG slowing of the low amplitudo Blood flow in the brain reduce usage of O2

16. 16 Differential Diagnosis Dementia Schizophrenia Psychosis Depression

17. DELIRIUM vs DEMENTIA?

18. 18 Therapy Treatment of underlying cause Medical care Drugs to control agitated and agressivebehaviour Antidepresssants (fluoxetine, citalopram) Dopamine blockers (haloperidol 5-10 mg/IM) Sedatives (clonazepam or diazepam) Thiamine Symptomatic therapy Antipsychotic : Benzodiazepine : diazepam 10 mg/IM

19. Complications Loss of ability to function or care for self Loss of ability to interact Progression to stupor or coma Side effects of medications used to treat the disorder

20. Prognosis often lasts only about 1 week, although it may take several weeks for mental function to return to normal Full recovery is common.