4.1 Psychiatric complications of physical disorders Flashcards
What are the typical features of delirium?
Impaired consciousness Disturbed cognition Psychomotor disturbance Disturbed sleep-wake cycle Emotional disturbance
Generally these features are rapid onset, transient and fluctuating, and may last days to months
What is the differential diagnosis of delirium?
Depression
Dementia
Post-stroke depression
Post-MI depression
What is the non-pharmacological management of delirium?
Tx cause
Manage environment
1. educate and raise awareness in staff
2. orient pt, clock, calendar, clear communication
3. Correct sensory impairments- glasses, hearing aids
4. Keep in bright side room, no unnecessary noise, remove unsafe objects
5. Ensure basic needs food/warmth/water met
What is the pharmacological management of delirium?
If alcohol withdrawal- reducing scale of diazepam or chlordiazepoxide
Otherwise: haloperidol 0.5-5mg in elderly - orally, then IM, max 10mg/24 hours
PARKINSONS, LEWY BODY DEMENTIA, NEUROLEPTIC SENSITIVITY: give LORAZEPAM 0.5-2mg up to 2x in 24H
Review frequently
What is delirium?
Impaired consciousness with intrusive abnormalities of perception and affect
What is the spectrum of impaired consciousness?
Common features of delirium: Impaired consciousness Disturbed cognition Psychomotor disturbance Disturbed sleep-wake cycle Emotional disturbance
Alert Clouding Drowsy Sopor- abnormally deep sleep Coma- GCS
What does disturbed cognition mean?
Common features of delirium: Impaired consciousness Disturbed cognition Psychomotor disturbance Disturbed sleep-wake cycle Emotional disturbance
Disorientation for time- but may be: place and person
Impaired memory and attention
Impaired thinking
Perceptual disturbance- hallucinations and illusions- Often visual in delirium
What is psychomotor disturbance?
Common features of delirium: Impaired consciousness Disturbed cognition Psychomotor disturbance Disturbed sleep-wake cycle Emotional disturbance
Hyperalert/hyperactive: agitation, hallucinations, aggression
Hypoalert/hypoactive: confusion, sedation, depression is ddx
Mixed: flux
What are types of sleep disturbances?
Common features of delirium: Impaired consciousness Disturbed cognition Psychomotor disturbance Disturbed sleep-wake cycle Emotional disturbance
Insomnia Sleep loss Reversal of sleep cycle Nocturnal worsening symptoms- sundowing Disturbing dreams and nightmares
What are types of emotional disturbances?
Common features of delirium: Impaired consciousness Disturbed cognition Psychomotor disturbance Disturbed sleep-wake cycle Emotional disturbance
'depression' anxiety fear irritability euphoria apathy perplexion aggression
What are main causes of delirium?
CVS: intracranial bleeds, MI, PE, cardiac failure
Resp: hypoxia
GI: liver failure, pancreatitis
Endo: diabetes or thyroid complication
Infection
GU: UTI, renal failure
Drugs: alcohol, drugs, rx drugs, withdrawal
Neuro: head injury, meningitis, encephalitis, tumours, epilepsy
Trauma: accident, sx
Neoplastic
What are major drug causes of delirium?
Alcohol Illicit drugs anticholinergics anticonvulsants - epilepsy antiparkinsonian - parkinson's steroids cimetidine opiates sedatives
Withdrawal from which drugs may cause delirium?
Alcohol
Sedatives, benzodiazepines
Barbiturates
Illicit drugs
Which metabolic states may cause delirium?
Hypoxia hypoglycaemia Liver/kidney disfunction fluid/electrolyte imbalance thyroid hormone imbalances hypopituitarism parathyroid imbalances porphyria carcinoid syndrome
Risk factors for delirium?
Elderly age Dementia or cognitive deficit Sensory deficits of blindness or deafness Previous episode Long sx or emergency sx Extremes of temperature Immobile Social isolation New environment Stress
