Dr.

I Gusti Ngurah Agastya

Narasumber: DR. dr. Martina Wiwie, Sp.KJ (K)

DELIRIUM
Definisi
Suatu sindrom yang etiologinya tidak
khas ditandai oleh gangguan kesadaran
yang bersamaan dengan gangguan
daya perhatian, persepsi, proses pikir,
daya ingat, perilaku psikomotor, emosi,
dan siklus tidur. (DSM V)
Definition
Delirium is characterized by an acute
decline in both the level of
consciousness and cognition with
particular impairment in attention.
Delirium often involves perceptual
disturbances, abnormal psychomotor
activity, and sleep cycle impairment.
(Kaplan)
Epidemiology
1 percent of the elderly population aged
55 or more have delirium,13 percent in
the 85 and older group.
10 to 15 percent of general surgical
patients, 30 percent of open heart
surgery patients, over 50 percent of
patients treated for hip fractures.
Epidemiology
Delirium occurs in 70 to 87 percent of
those in intensive care units, up to 83
percent of all patients at the end of life
care.
The mortality rates among hospitalized
patients with delirium range from 22 to
76 percent
The 1-year mortality rate associated with
cases of delirium is 35 to 40 percent.
Predisposing Factors for Delirium

Demographic characteristics: Age 65 and

older, Male sex
Cognitive status: Dementia Cognitive
impairment , History of delirium, Depression
Functional Status: Functional dependence,
Immobility, History of falls, Low level of
activity
Sensory Impairment: Hearing and Visual
Decreased Oral Intake: Dehydration and
Malnutrition
Predisposing Factors for Delirium

Drugs: Treatment with psychoactive drugs,

Treatment with drugs with anticholinergic
properties, Alcohol abuse
Coexisting Medical Conditions: Severe
medical diseases, Chronic renal or hepatic
disease, Stroke, Neurological disease,
Metabolic derangements, Infection with
human immunodeficiency virus, Fractures
or trauma, Terminal diseases
Pathophysiology
Acetylcholine: serum anticholinergic activity
is increased in patients with delirium
Dopamine: Dopaminergic excess
Glutamate: neurotoxicity effects (mediated
via the N-methyl-D-aspartate [NMDA]
receptor), may cause neuronal death and
can be associated with delirium
GABA
Serotonin
Pathophysiology
Oxidative Metabolism: Disturbance in
brain oxygen supply versus demand
BloodBrain Barrier Alterations: CNS
response to systemic inflammation during
a state of bloodbrain barrier compromise
Ammonia: induce and aggravate
astrocyte swelling, increased glutamate
and glutamine levels, which are
precursors to GABA
Diagnostic Criteria DSM
V
PPDGJ-III Kriteria Delirium
F05: Delirium, bukan akibat alkohol dan zat psikoaktif
lainnya.
F05.0: Delirium, tak bertumpang tindih dengan
demensia.
F05.1: Delirium, bertumpang tindih dengan demensia.
F05.8: Delirium lainnya.
F05.9: Delirium yang tidak digolongkan
PPDGJ-III
F1x.4 Keadaan putus zat dengan delirium
F1x.40 Tanpa konvulsi
F1x.41 dengan konvulsi
Dikutip dari: http://openi.nlm.nih.gov/imgs/rescaled512/2736510_PSM-03-
01-t-003.png
 Examination

Confusion assesment method

Richmond agitation sedation scale
Nonpharmacologic
Treatment
maximizing the safety of the environment and providing
psychosocial support.
Environmental changes involve enhancing the patient's
ability to interpret the surroundings appropriately.
Modifying the patients surroundings.
Maintenance of patient comfort
Physical activity should be initiated as soon as possible
Interruptions of sleep should be minimized when
possible
Adequate nutrition
Pharmacotherapy
Algoritme Delirium
Thank You