Delirium History May not be possible for patients Take a collateral history Check medical records and notes The presenting complaint is confusion and memory loss. Time questions Progression Fast -> delirium Slowly progressive -> dementia or Alzheimer’s Step like -> vascular Context Triggers Ideas Reliving factors Aggravating factors Associated features consciousness Depression Psychiatric symptoms e.g. hallucinations, delusions, etc. Behavioural changes: agitation, aggression, wandering, disinhibition, calling out. Sleeping patterns. Awake at night -> AD Early waking in the morning -> depression Cognitive disturbances: Aphasia Apraxia Agnosia Difficulty planning/organising Fever Pain Fatigue Excess sleep Medications Prescription Non-prescription Past medical history Vaccinations Allergies Surgery Social history Diet Smoking Alcohol Recreational drugs Diet Exercise Living situations Stressors Daily activity Differentials Hyperactive delirium Agitation Delusions Hallucinations Wandering Aggression Hypoactive Lethargy Slowness in everyday tasks Excessive sleeping Inattention Causes Constipation Hypoxia Infection Metabolic disturbances Pain Sleeplessness Prescription Hypothermia/pyrexia Organ dysfunction -> hepatic or renal impairment Nutrition Environmental changes Drugs Over the counter Illicit Alcohol Smoking Sedative hypotonic e.g. benzodiazepines Analgesics e.g. opioids -> morphine, oxycodone, fentanyl or other drugs used for pain management Anticholinergics e.g. antihistamines, tricyclic anti-depressants. Corticosteroids Muscle relaxants Anti-hypertensives e.g. BB, CCB. Lithium Narcotics -> substances used to treat moderate to severe pain.