From the corridor, hypoactive delirium looks like sleep.

Inside: "I could hear everything.

I just couldn't reach the surface."

Speak to the still patient as if they can hear you.

Often they can, and they remember.

#delirium

Delirium isn't always preventable. But this cascade, one problem setting off the next, need not have run its course.

Recognise the delirium early and what follows likely changes.

#delirium

4AT (a delirium test) teaching example: a patient becomes agitated after bowel surgery.

Alertness 4, AMT4 (age, date of birth, place, year) 2, attention (months backwards) 1, acute change 4.

Total 11 out of 12: possible delirium.

Refusing to start months backwards scores 1.

#Delirium

Yesterday he was chatting. Today he doesn't know where he is.

That is a sudden change. It needs a medical assessment now, not "he's probably tired".

Worried about delirium and not being heard? Ask again. Ask for the nurse in charge.

More for families at deliriumsupport.com

#delirium

“Reality itself fragmented into a #delirium of shifting images, as if a fever had seized our senses and the world had become an unreliable mirage.”

Philip K Dick, Ubik (1969)

5 tips for communicating with older adults with #delirium - from the Regional Geriatric Program of Toronto.

Interested in delirium-related distress? A team at the University of Technology Sydney is looking for study participants for research into this important topic. Learn more below and at the link: redcap.link/deliriumdelphi

#Delirium

Family: "I've known him 60 years. This is not him."

Chart: "Confused."

One of these is clinical data.

One is lay description masquerading as a diagnosis.

Calling delirium "confusion" is poor practice.

#delirium

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

Delirium is open access: €20 to submit and a €280 APC on acceptance. Peer review is estimated to take 4 to 6 weeks under normal circumstances.

deliriumjournal.com/for-aut...

#Delirium

4AT teaching example: a quiet, withdrawn patient with pneumonia. Alertness 0, AMT4 2, attention 1, acute change 4. Total 7/12: possible delirium.

Being fully awake does not exclude delirium. #Delirium

Repeated assessment is necessary because delirium fluctuates.

Timing can change what the examiner sees.

#delirium

Loss of privacy can worsen distress during delirium.

Preserve dignity while urgent care continues.

#delirium

Mesopotamian Diagnostic Handbook (Sakikkû) ~1050 BC:

"If a stroke has struck him & his forehead seizes him all the time, he sees his providing spirit; variant: he sees the Provider-of-Evil; he will die."

One of the earliest known descriptions of #delirium

There's still time to register for our September webinar. Don't miss this talk from expert Dr. Colm Cunningham on disrupted brain energy metabolism and delirium. Register here:
northeastern.zoom.us/meeting/regi...

#Delirium

NB: A patient can be fully orientated and still delirious.

The core feature of delirium is inattention. Test it: months of the year backwards. Do not rely on orientation questions alone.

Attention/arousal = a vital sign of the brain. #delirium

4AT scoring example after hip fracture surgery: abnormal alertness 4 + untestable AMT4 2 + untestable attention 2 + acute change 4 = 12/12. Possible delirium; clinical assessment is needed. #Delirium

You can test attention with nothing but your voice: months backwards, days backwards, serial sevens, spell WORLD backwards, digits reversed.

Under a minute, no kit. Alongside subjective assessment of attention, writing cognitive test results down can help to track change/recovery. 

#delirium

Communication should continue after the acute episode.

Ask what the person remembers and offer a plain account of what happened.

#delirium

Delirium prevention usually needs several actions together.

A single checklist item rarely covers the person’s risks.

#delirium

Baseline neurocognitive vulnerability, such as dementia, prior #delirium, and heavy #alcohol use, independently predicted consultation-confirmed delirium among hospitalized patients.

https://www.psychiatryadvisor.com/news/dementia-and-prior-delirium-predict-consultation-confirmed-delirium/