Dr Sarah Constantine Consultant Psychiatrist Basingstoke Delirium

Delirium Has a low prevalence in the community Usually transitory and associated with other illness Within hospital population is common Varies with demographic of ward

Definition of Delirium 1 Impairment of attention and concentration- variable Global cognitive disturbance- affecting memory and new learning May present with disordered thought and logic processes Impairment of orientation, particularly to time and place Psychomotor disturbance- hyper- or hypo- activity which may switch

Definition of delirium 2 Disturbance of sleep/wake cycle- insomnia, sleep reversal, daytime drowsiness, dreams Emotional disturbance- anxiety, euphoria, apathy, irritability, fear, depression Transient and fluctuant intensity

Predisposing factors to delirium Age Disease of the brain (including dementia) Environment Sleep disturbance Drugs and alcohol- acute and chronic effects and withdrawal

Precipitating factors for delirium Any physical illness Drugs

Treatment of delirium Aim to establish the diagnosis and then treat the cause Person centred care Underlying condition specific treatments Fluids Nourishment Excretion Reality orientation Reassurance Rest Sedation

Risks of delirium A highly risky condition Death Self harm Harm to others Falls Wandering

Capacity and delirium Remember, fluctuant nature Remember, transitory condition Remember, need to assess only what is immediately necessary Remember, need to assess when is at best Best interests Least restrictive option