Consultant-Liaison Flashcards
Common neurocognitive deficits associated with brain tumors and whst they can be confused with
Low energy, fatigue, urge to sleep, loss of interest in daily activities, abulic, lack spontaneity. Can be confused with depression
Most common clinical symptoms at the time of first manifestation of autoimmune encephalitis?
Psychotic symptoms
Warning signs of autoimmune encephalitis
- psychotic symptoms
- subacute onset (rapid progression within 3 months despite psychopharmacotherapy)
- decreased consciousness level
- memory deficits/disorientation
- catatonia
- speech dysfunction
- abnormal posture/movement
- autonomic dysfunction
- hyponatremia
- other autoimmune dx
- epileptic seizures/faciobrachial dystonic seizures
Normal pressure hydrocephalus
Wet: urinary incontinence
Wobbly: gait disturbance
Wacky: cognitive impairment
What can steroids cause
Euphoria, hypo mania, depression, mood issues, cognition, sleep, delirium, psychosis
What does Yasmin and Beta blocker increase risk of
Depression
What can ketamine cause
Dissociation associated with confusion, fear or euphoria
What can levodopa cause
Depression, psychosis, impulse control disorders
What can levitiracetam cause
Behavioural changes like agitation, irritability, depression, anxiety
Cushing’s syndrome assoc with
Depression, mania, psychosis
Pheochromocytoma
Anxiety
Addison’s disease
Depression, psychosis, anxiety, mania
Fatigue, LOW, salt craving, hypotension, hypopigmentation
PCOS
Depression, anxiety, OCD, bipolar, schiz
Delirium criteria
A. Disturbance in attention and awareness (orientation to environment)
B. It develops over a short period of time (hours to days) and is a change from baseline awareness, tends to fluctuate in severity over a course of a day
C. An additional disturbance in cognition (eg memory, disorientation, language, visuospatial ability, perception
D. disturbances in A&C not better explained by other pre-existing neurocognitive disorder and do not occur in the context of a severely reduced level of arousal like coma
E. there is evidence from history, PE, or lab findings that disturbance is a direct physiological consequence of another medical condition, substance intoxication or withdrawal or exposure to toxins or has multiple etiologies
Risk factors for delirium
65 and above, cognitive impairment, hip fracture, severe physical illness, history of depression, use of physical restraints, poly pharmacy, post-op, past episodes of delirium, ICU admission, sleep deprivation, substance withdrawal
Assessment of delirium
History and PE: vital signs, alertness level, eyes, urine, mucous membranes, skin
Confusion Assessment Method
RBG, ABG, ECG, urinalysis
FBC, UEC, LFT, TFT, urine drug screen, BAL, therapeutics drug levels
May need CT/MRI, EEG, LP
Management of delirium
Treat underlying cause
Environment: quiet, low light, orienting strategies, family visiting, constant nurse
Pharmacology
- haloperidol
- benzo only for alcohol/benzo withdrawal
Minimize risks associated with delirium
Ensure regular food, fluid, bowl motions
Encourage mobility, sleep hygiene
Manage pain and avoid bed sores
Educate family
