PsychRounds: The Psychiatry Podcast Delirium with Dr. Lorrie Garces
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Jul 4, 2024 Dr. Lorrie Garces, a consultation-liaison psychiatrist, shares vital insights on delirium and its complexities. She defines delirium and explains its common causes, emphasizing the importance of recognizing hypoactive forms often missed in clinical settings. The discussion covers effective screening tools and non-pharmacological treatments that prioritize patient comfort. Dr. Garces also addresses medication use, particularly the cautious approach to antipsychotics, and highlights the significant impact of environmental and familial support on recovery.
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Delirium Defined As Acute Brain Dysfunction
- Delirium is an acute disturbance in attention and cognition not explained by neurocognitive disorder.
- Multiple terms (encephalopathy, altered mental status) describe the same clinical picture.
Multifactorial Causes And Risk Model
- Delirium usually has multifactorial causes combining vulnerability and precipitating insults.
- Older age, ICU setting, dementia, and severe illness increase vulnerability and incidence.
Use Brief Attention-Focused Screens
- Use brief screens like the 4AT to assess alertness, orientation, attention, and acute change.
- Test sustained attention directly (months backwards, serial sevens) rather than focusing on calculation steps.