376.2 🩺 國考版

376.2.1 高頻考點

376.2.1.1 DSM-5 Criteria

  1. Disturbance in attention + awareness
  2. Develops short period, fluctuates
  3. Cognitive disturbance
  4. Not better explained
  5. Evidence of physiological cause

376.2.1.2 Hallmark

  • Inattention

376.2.1.3 Subtypes

  • Hyperactive
  • Hypoactive (most common, often missed)
  • Mixed

376.2.1.4 Risk Factors

  • Age > 65
  • Dementia
  • Prior delirium
  • Severe illness
  • Sensory impairment

376.2.1.5 Common Precipitants

  • Medications (#1 anticholinergic, BZD, opioid)
  • Infection (UTI, pneumonia)
  • Metabolic
  • Withdrawal
  • Surgery
  • ICU

376.2.1.6 CAM (Confusion Assessment Method)

  • 1: Acute onset + fluctuating, AND
  • 2: Inattention, AND EITHER
  • 3: Disorganized thinking, OR
  • 4: Altered LOC

376.2.1.7 Delirium vs Dementia

Delirium Dementia
Acute Insidious
Fluctuating Progressive
Inattention hallmark Memory hallmark
Often reversible Usually not
Days-weeks Months-years

376.2.1.8 HELP Program

  • Reorientation
  • Sleep enhancement
  • Mobility
  • Hearing + vision aids
  • Hydration
  • Family involvement
  • Avoid restraints

376.2.1.9 Pharmacologic Last Resort

  • Low-dose haloperidol 0.5-1 mg
  • Quetiapine (PD, DLB)
  • Risperidone
  • AVOID benzodiazepines (paradoxical) except alcohol/BZD withdrawal
  • ECG check (QT)

376.2.1.10 Alcohol Withdrawal Delirium (DTs)

  • 48-96 hr after last drink
  • Severe agitation, hallucinations, autonomic
  • BZDs first-line
  • Thiamine before glucose
  • Mortality 5-15% if untreated

376.2.1.11 ICU Delirium

  • 50-80% of ICU patients
  • ABCDEF bundle
  • Dexmedetomidine over BZDs
  • CAM-ICU screening

376.2.1.12 Drug-Induced Delirium Mnemonic

  • A: Anticholinergics
  • B: Benzodiazepines
  • C: Cardiovascular (digoxin, diuretics, β-blockers)
  • D: Drugs (illicit)
  • E: ENT (antihistamines)
  • F: Furosemide (electrolyte)
  • G: GI (H2 blockers, antiemetics)
  • H: Hormones (steroids)

376.2.1.13 Anticholinergic Burden

  • ACB Scale, Beers Criteria
  • Cumulative anticholinergic load
  • Common offenders: oxybutynin, scopolamine, diphenhydramine, TCAs, low-potency antipsychotics

376.2.2 Specific Causes

376.2.2.1 UTI in Elderly

  • Often presents only with delirium
  • Treat
  • But avoid overtreatment of asymptomatic bacteriuria

376.2.2.2 Constipation

  • Common contributor
  • Often overlooked
  • Disimpaction + bowel regimen

376.2.2.3 Urinary Retention

  • Bladder scan
  • Catheter if needed

376.2.2.4 Hyponatremia

  • Common cause
  • Especially SIADH, thiazides
  • Careful correction