Delirium and alcohol Flashcards
5 psychosocial effects of alcohol
domestics issues- abuse, violence divorce loss of job loss of custody murders fights NHS resources
4 techniques for reducing alcohol intake in the UK
make alcohol less affordable
minimum price per unit
reduce outlets selling alcohol
ban on advertising
define delirium
“an acute or subacute, usually reversible syndrome of impaired higher cortical functions hallmarked by generalised cognitive disturbance and caused by one or more aetiologies”
describe the core features of delirium
-Acute or Subacute onset and fluctuates
-Disturbance of consciousness
reduced awareness of environment,
reduced ability to focus, sustain, or shift attention
-Diffuse cognitive deficits
-Sleep-wake disturbance
-Slow/muddled thinking with complex content
-Language impairment
-Psychosis (visual hallucinations) and Illusions
-Psychomotor behavioural disturbance
-Altered or labile affect
4 key stages of an assessment for delirium
Hx- alcohol and drugs
co-existing medical/psychiatric disorders
physical exam
Ix- urine dip, FBC, U&E, LFTs, INR, PT, urinary drug screen
3 causes for delirium
alcohol withdrawal GI haemorrhage Pancreatitis dehydration constipation hypoxia pain
describe the pathophys of delirium
Normal brain function - organized and interconnected structure allowing complex integration of sensory information and motor responses.
Delirium - failure in the integration and appropriate processing of information
A hypothesis is proposed that delirium results from an acute breakdown in network connectivity within the brain.
describe alcohol neuronal damage (4 things)
Peripheral Neuropathy
Cerebellar Degeneration
Demyelination
pellagra- vit B3 def
What is the triad for wernicke’s encephalopathy
ataxia
opthalmoplegia
nystagmus
what areas of the brain are affected by thiamine deficiency
thalamus mamillary bodies cerebellum 3rd and 4th ventricles periaqueductal grey area posterior hypothalamus
3 mechanisms through which alcoholism contributes to thiamine deficiency
inadequate nutritional intake
Decreased absorption of thiamine from GI tract and reduced uptake into cells
Impaired utilization of thiamine in the cells
3 potential mechanisms for how thiamine deficiency can lead to brain damage
lactate accumulation
glutamate accumulation
free radical production
dose of pabrinex to be given in alcohol abuse
PO pabrinex 300mg OD
