Dr. Fick shared this terrific fishbone diagram listing causes of undetected #delirium in healthcare settings.

She also noted @amaclullich.bsky.social's seminal work in delirium, including the development of 4AT. #medsky

Next: "Detecting and Managing #Delirium in Persons with #Dementia: Integrating Technology & Human Intelligence" by Donna Fick, PhD, RN, GCNS-BC, FAAN, @pennstateuniv.bsky.social.

www.nursing.psu.edu/directory/fi...

“When reality dissolves into confusion and fright, do not judge the shadow—search for what hides beneath the night.”
#DarkPoetry #Delirium #MentalHealthAwareness #Caregiving #Compassion

Delirium tremens de la chatte

Le delirium tremens est une forme aiguë de sevrage alcoolique, caractérisée par des tremblements, des hallucinations et une confusion mentale. #Delirium #tremens #sevrage #alcool #hallucinations

Delirium de la chatte

Le délire est un état mental caractérisé par une confusion aiguë, des hallucinations et une perturbation de la perception de la réalité, généralement transitoire et causé par des troubles physiologiques ou psychologiques. #Delirium #etat #mental #confusion #hallucinations

Publishing delirium research should not require a four-figure fee.

Delirium is open access: €20 to submit and a €280 publishing charge (APC) on acceptance.

Peer review is estimated to take 4 to 6 weeks under normal circumstances.

deliriumjournal.com/for-aut...

#Delirium

The most important cognitive test in surgery happens before it starts.

Without a pre-op baseline (how the person thinks normally), "confused, query baseline" (was this their normal?) is guesswork.

Four minutes at pre-assessment turns it into diagnosis.

#periop #delirium

4AT (a delirium test) example: severe dementia, no acute change.

Untestable AMT4 (four questions) and months backwards each score 2: total 4 out of 12.

The 4AT still gives a score when testing is not possible.

Informant history and observation over time are particularly important here.

#Delirium

"I was in a fever, and everything seemed to be spinning around me."

Gitanjali (Poem), Rabindranath Tagore

#delirium

“She would lie in her bed really quietly. . . but she always had this frightened look on her face and when her family came to visit . . . they told us that . . . she felt really scared because she was seeing someone in the room with her.”

#Delirium

4AT (delirium test) teaching example: a care home resident is alert, makes two or more mistakes on the AMT4 (age, birth date, place, year) and says six months backwards. Staff report no sudden change.

Alertness 0, AMT4 2, attention 1, change 0: 3 out of 12, possible cognitive impairment.

#Delirium

Protecting sleep is delirium prevention you can start tonight.

By day: daylight, activity, out of bed.

By night: dark, quiet, no unnecessary obs (routine pulse and blood pressure checks), no 3am tablets that could wait. Strong evidence, no cost.

#delirium

“A bit confused, but she’s 79.”

Her son: she did the crossword this morning. In pen.

4AT 7/12 (delirium test, positive at 4 or more). Fractured pelvis, 600 ml stuck in the bladder.

“A bit confused” is a description.

Delirium is a diagnosis that stimulates a plan. 

#delirium

4AT (a delirium test) scoring example: alert, no mistakes on the AMT4 (age, date of birth, place, year), but refuses to start months backwards. That refusal scores 1.

His daughter reports a new change, scoring 4. Total: 5 out of 12. Possible delirium.

#Delirium

Study spotlight: 158 randomised trials pooled to compare drugs, 41,084 patients (Luney et al., BMJ 2026).

Dexmedetomidine (a sedative) prevented postoperative delirium; most drugs changed neither deaths nor thinking.

Prevention still depends mainly on the basics.

#delirium

When sudden confusion enters the mind,
do not assume that dementia is behind.
A sudden change can be a warning to see,
medical assessment may hold the key.
#Delirium #ElderCare #MentalHealth #Caregiving #DarkPoetry

For delirium researchers:

Publishing delirium research should not require a four-figure fee.

Delirium is open access: €20 to submit and a €280 publishing charge (APC) on acceptance.

Peer review normally takes an estimated 4 to 6 weeks.

deliriumjournal.com/for-aut...

#Delirium

4AT (a delirium test) teaching example: normal alertness, no mistakes on the AMT4 (four questions) and correct months backwards.

His daughter reports new hallucinations.

Acute change 4, the other three items 0: 4 out of 12.

Item 4 alone gives a positive screen for possible delirium.

#Delirium

As people become older and more frail, sometimes the doses of drugs that they are on become toxic.

This can also happen acutely. Especially in the presence of acute injury.

This is why medication review as part of delirium care is so important.

#delirium