14. Consultation Liaison Psychiatry

Question 1

DSM 5 diagnostic criteria for delirium

Answer 1

1. Changes in attention and awareness
2. Changes must have developed over a short duration of time (within hours to few days) and represent a change from baseline attention and awareness
   - Fluctuating during course of the day
3. Disturbance in cognition

Question 2

Conditions causing Delirium

Answer 2

I WATCH DEATH RC

Infections
- encephalitis, meningitis, syphilis, pneumonia, UTI

Withdrawal
- from alcohol or sedative-hypnotics
Acute metabolic
- acidosis, alkalosis, electrolyte disturbances, liver or kidney failure
Trauma
- heat stroke, burns, surgery
CNS pathology
- abscess, hemorrhage, seizure, stroke, tumour, vasculitis, NPH
Hypoxia
- anemia, CO poisoning, hypotension, pulmonary embolism

Deficiencies
- vitamin B12, niacin, thiamine
Endocrinopathies
- hypo/hyper-glycemia, hypo/hyper-thryroidism
Acute vascular
- HTN encephalopathy, shock
Toxins or drugs
Heavy metals

Recent alteration in medications
Changes in environment

Question 3

Subtypes of Delirium

Answer 3

• Hyperactive: heightened arousal, restlessness, agitation, hallucinations, inappropriate behaviour
• Hypoactive: lethargy, reduced motor activity, incoherent speech, lack of interest
• Mixed: combination of hyperactive and hypoactive

Question 4

Confusion Assessment Method

Answer 4

A. Acute onset and fluctuation course
B. Inattention

and the presence of either C or D
C. Disorganised thinking
D. Altered level of consciousness

Question 5

What will the EEG show in a delirious patient?

Answer 5

Generalised slowing to theta-delta range (resolution with effective treatment)

Question 6

Risk factors for developing delirium include:

Answer 6

Old age
Polypharmacy
Anemia
Electrolyte disturbance
History of substance misuse

Question 7

Non-pharmacological management of delirium

Answer 7

Good ward management
- Quiet, calm environment
- Reorientation
- Minimise transfers
- Presence of family members
- Ensure safety

Psychoeducation of carers

Question 8

Pharmaco management of delirium

Answer 8

Antipsychotics & pain management
*increased risk of death when used to treat behavioural problems in dementia pts
*BZD can cause confusion in elderly

Question 9

Onset of postnatal blues, postnatal depression, puerperal psychosis

Answer 9

Postnatal blues: 3-5 days
Postnatal depression: 2-4 weeks
Puerperal psychosis: 1-6 weeks

Question 10

Predictive factors of Postnatal depression

Answer 10

Personal
- Old age
- Low socioeconomic status
- Past psych hx
- Substance abuse

Social
- Poor social support
- Poor marital relationship
- Stressful life events

Pregnancy
- Complications

Question 11

Common symptoms of PND

Answer 11

• Irritability
• Tearfulness
• Poor sleep
• Tiredness

Question 12

Common presentations

Answer 12

• Low mood
• Feeling inadequate as a mother
• Loss of confidence
• Anxieties about baby’s health
• Concerns that the baby is malformed
• Reluctance to feed or handle baby
• Thoughts of harming baby

Question 13

Common delusions in puerperal psychosis include

Answer 13

• Baby is a demon
• Baby has been replaced by an imposter

Question 14

Questionnaire to screen for PND

Answer 14

Edinburgh PND scale

Question 15

Risk factors for postpartum psychosis

Answer 15

Previous episode of postpartum psychosis
Personal history of bipolar or depressive disorder or schizophrenia
Obstetrics complications

Question 16

S/E of SSRI during pregnancy

Answer 16

Increased risk of post partum hemorrhage
Decreased gestational age
Decreased birth weight
Increased risk of persistent pulmonary hypertension of newborn
3rd trimester use might result in discontinuation symptoms in the neonate

Question 17

Post natal blues vs post natal depression

Answer 17

Symptoms worsening of persisting beyond 2 weeks in PND
Presence of suicidal ideations
Functional impairment