Features of delirium, dementia and psychosis/psychiatric disorder

Delirium Dementia Psychiatric illness

Age any elderly < 40
If > 40 organic cause until proven otherwise
Onset Acute/days Insidious Acute - week/months
Course Fluctuating progressive Cycling, episodic
Consciousness Reduced or hyperalert Alert Alert
Attention Disordered Normal May be disordered
Cognition Globally impaired Impaired May be impaired
Orientation Impaired Often impaired May be impaired
Hallucinations Visual > auditory Often absent Usually auditory
Thought/Delusions Transient Usually absent Sustained and thought disorganization, thought insertion,
loosening of associations, flight of ideas
Movements Asterixis, tremor, Often absent Agitation common; look for dystonia, tremor, catatonia DDx
agitation NMS, medication induced
Idiosyncracies Loss of short term memory Positive symptoms acute psychosis
Negative Sx: blunted affect, withdrawal, anhedonia,
apathy
related to functional (social, occupational) dysfunction

PMHx Prior episodes, multiple comorbidities, Often multiple comorbidities Previous psychiatric Hx
drug&alcohol
Meds Anticholinergics Non specific Steroids, anticholinergics
Sedatives, opioids Hallucinogens, sympathomimetics
Narcotics, steroids Withdrawal, NMS, serotonergic Sx
Physical/exam Unwell, abnormal VS, fever, tremor, Often presenting with new Non specific
focal neurology, evidence trauma onset of infective Sx Assess for abnormal VS, fever, neurologic deficit

Ix guided by clinical findings and Hx aim to differentiate delirium from dementia and psychosis and to seek organic etiology

Comprehensive screen for orangic causes may include

Septic Screen: Urine UTI very common in elderly, CXR pneumonia, Blood cultures
BSL hypo-/hyperglycaemia
Ecg ischaemia, dysrhythmias + CXR CCF
ABG as valuable screen (Na, Ca, O2 hypoxia, pCO2 hypercapnia, acid-base)
FBE aneamia, infective
UEs hyponatraemia/-calcaemia, ARF
LFT acute liver failure
TFTs thyroid storm, myxoedema
CT for recent falls, trauma and/or focal neurology
Drug screen
HIV ( consent)

SCZ
psychiatric
depression x4 more
common than SCZ
BPD

hallucinogens
sympathomimetics
drug
steroids
induced
anticholinergics
alcohol (withdrawal)

hypoglycaemia
hyponatraemia/hypercalca
emia
hypxia/hypercapnia
medical Neuro: stroke, postictal,
mass lesion
Endo: Thyroid disorder,
Adrenal crisis, Cushing's
Trauma
Psychosis etiology