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Psychiatry > Delirium and Dementia > Flashcards

Delirium and Dementia Flashcards

1
Q

Delerium

A
  • Acute transient and global organic disorder of CNS functioning.
  • Resulting in impaired consciousness, and attention.
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2
Q

Categories of RF of Delerium

A

HE IS NOT MAD
Hypoxia
Endocrine
Infection
Stroke
Nutrition
Other
Theatre
Metabolic
Abdominal
Alcohol
Drugs

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3
Q

Hypoxia RF for delirium

A

resp failure, MI, cardiac failure, pulmonary embolism

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4
Q

Endocrine associated delirium cause

A

hyperthyroid, hypothyroid, hyper or hypoglycaemia, cushings

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5
Q

Stroke associated delirium cause

A

stroke, raised ICP, intracranial haemorrhage or infection, space occupying lesions, head trauma, epilepsy

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5
Q

Nutrition related delirium cause

A

dec thiamine, nictotininc acid or B12

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6
Q

Other causes of delirium

A

pain, sensory deprivation, relocation, sleep deprivation

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7
Q

Theatre causes of delerium

A

anaesthesia, opiate analgesics, sepsis

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8
Q

Metabolic causes of delerium

A

hypoxia, electrolyte disturbance, hepatic impairment

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9
Q

Abdominal causes of delirium

A

faecal impaction, malnutrition, urinary retention or bladder catheterisation.

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10
Q

Symptoms of delirium

A

DELIRIUM

  • Disordered thinking
  • Euphoric, fearful, depressed or angry
  • Language impaired
  • Illusions, delusions
  • Reversal of sleep wake pattern
  • Inattention
  • Unaware / disoriented
  • Memory deficits
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11
Q

Examination delirium

A
  • Collateral history
  • Rate and onset of confusion
  • Underlying causes?
  • Understanding of premorbid state
  • Hypersensitivity?
  • Drug and alcohol history
  • Disturbances - hallucinations etc.
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12
Q

MSE delrium

A

Appearance - hypo or hyper alert, aggressive or purposeless behaviour

Speech - incoherent or rambling

Mood - low, irritable or anxious. Often labile

Thought - confused, ideas or reference, delusions

Perception - Illusions, hallucinations, misinterpretations

Cognition - disoriented, impaired memory, reduced conc and attention

Insight - poor

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13
Q

Hypoactive delirium

A
  • Lethargy, dec motor activity and sleepiness
  • Most common but also most unrecognised
  • Can be confused with depression
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14
Q

Hyperactive delirium

A
  • Agitation, irritability and restlessness with aggression
  • Hallucinations and delusions prominent
  • May be confused with functional psychoses
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15
Q

Mixed Delirium

A

Both hypo and hyper and signs of both.

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16
Q

Treatment delirium

A
  • Underlying causes - infections, electrolyte disturbances, offending drugs, laxatives for faecal impaction, analgesia
  • Reassurance and re-orientation - reduce anxiety and disorientation
  • Provide appropriate environment - quiet, well lit room. Consistency in care and staff, reassuring nursing staff, familiar person - family or friends.
  • Managing disturbed or violent / distressed behaviour
  • encourage oral intake and pay attention to constinence. Verbal and non verbal deescalation techniques.
    Avoid benzos and use low dose haloperidol
17
Q

Ix Delirium

A
  • Routine
  • ABG, CT head, Lumbar puncture - depending on symptoms
  • Diagnostic questionnaires
    • Abbreviated mental test AMT
    • Confusion assessment method CAM
    • MMSE
18
Q

Ddx delirium

A
  • Dementia
  • Mood disorders
  • Late onset schizophrenia
  • Dissociative disorders
  • Hypothyroidism and hyperthyroid
18
Q

Complications delirium

A
  • Death
  • Increased length of stay in hospital
  • Dementia
  • Falls
  • Pressure sores
  • Functional impairment
  • Distress for person / family / carers.
  • Nosocomial infections
19
Q

Biological treatment considerations for delirium

A

Antipsychotics and benzos are never first line for managing delirium and providing reassurance and re-orientation and appropriate environment are main means - NICE.

Low dose antipsychotics are only to be used as last resort incase of violent or severely distressed behaviour.

20
Q

Delirium vs Dementia
Sleep wake
Attention
Arousal
Autonomic features
Duration
Delusions
Course
Consciousness
Hallucinations
Onset
Psychomotor activity

A

Delirium

Disrupted
Markedly reduced
Increased or decreased
Abnormal
Hours to weeks
Fleeting
Fluctuating
Impaired
Common
Acute or subacute
Abnormal

Dementia

Normal
Normal
Normal
normal
Months to years
complex
stable / slow
no impairment
less common
chronic
normal

21
Q

AMT - abbreviated mental test

A
  1. Age
  2. Time to nearest hour
  3. Recall address at end
  4. What year
  5. Location
  6. Identify 2 people
  7. DOB
  8. WW1
    9.Current monarch
  9. Count backwards from 20 to 1

> =8 means impairment unlikely

22
Q

CAM - confusion assessment method

A

1 and 2 + either 3 or 4
1. Acute onset and fluctuating course
2. Inattention
3. Disorganised thinking
4. Alteration in consciousness.

23
Q

Dementia

A

Generalised decline of memory, intellect and personality without impairment of consciousness - leading to functional impairment

24
Q

Cause of AZ

A

degeneration of cholinergic neurone in the nucleus basalis of meynert, leading to a deficiency of acetylcholine.

25
Q

Microscopic and macroscopic findings of AZ

A
  • Microscopic - neurofibrillary tangles and B amyloid plaque formation
  • Macroscopic - cortical atrophy - common hippocampal. Widened sulk and enlarged ventricles.
26
Q

Irreversible causes dementia

A
  • Neurodegenerative
  • Infections - HIV, encephalitis, syphillis, CJD
  • Toxins - Alcohol, barbiturates, benzodiazepines
  • Vascular - vascular dementia, multi-infarct dementia, CVD
  • Traumatic head injury
27
Q

Reversible causes dementia

A
  • Neuro - normal pressure hydrocephalus, intracranial tumours, chronic subdural haematoma.
  • Vitamin deficiencies - B12, folic acid, thiamine, nicotinic acid
  • Endocrine - Cushing syndrome, hypothyroidism

DEMENTIA

  • Drugs - barbiturates
  • Eyes and ears - visual or hearing impairment
  • Metabolic - bushings / hypothyroidism
  • Emotional
  • Nutritional deficiencies / normal pressure hydrocephalus
  • Tumours / Trauma
  • Infections
  • Alcoholism / Athersclerosis
28
Q

MSE Dementia

A

Appearance - unkempt
Speech - slow and confused, repetitive
Mood - low or normal
Thought - delusions
Perception - hallucinations in DLB.
Cognition - Affected in all dementia but varying degrees
Insight - Preserved initially but lost in latter stages.

29
Q

Types of dementia

A
  • Alzheimers
  • Vascular - as a result of cerebrovascular disease
  • Dementia with Lewy bodies
  • Fronto temporal dementia -
  • Other causes
  • Dementia in Parkinsonism - Parkinsons first then dementia
30
Q

DLB

A

Dementia then Parkinsons -

abnormal deposition of protein within the neuron’s of the brainstem, substantia nigra and neocortex.

Outside brainstem, LB are associated with more profound cholinergic loss than in AD.

Within brainstem more dopaminergic loss and parkinsonian like symptoms.

31
Q

FTD

A

atrophy of frontal and temporal lobes of the brain. Picks disease - protein tangles (pick body) seen histologically.
Frontotemporal dementia

32
Q

Cortical and Subcortical dementia

A

Cortical - AD and FTD

Subcortical dementias - DLB

Mixed - Vascular

33
Q

Cortical vs subcortical dementia
Memory loss
Mood
Speech
Personality
Coordination
Praxis
Motor speed

A

Cortical
Severe
normal
early aphasia
indifferent
normal
apraxia
normal

Subcortical
Moderate
low
dysarthria
apathetic
impaired
normal
slow

34
Q

ICD-10 for dementia

A
  • Evidence of the following
    • Decline in memory
    • Decline in other cognitive abilities - deterioration in judgement and thinking such as planning or organising.
  • Preserved awareness of the environment for a period of time long enough to demonstrate
  • A decline in emotional control or motivation, or change in social behaviour manifested by one of the following:
    • Emotional lability
    • Irritability
    • Apathy
    • Coarsening of social behaviour
  • For a confident diagnosis - must have been present for at least 6 months
35
Q

10 step examination dementia

A
  • Routine investigations
  • Urine dipstick
  • Chest Xray
  • Sypholis serology and HIV testing
  • Brain imaging
  • ECG
  • EEG
  • Lumbar puncture
  • Genetic tests
  • Cognitive assessment
36
Q

Ddx dementia

A

Normal ageing

Mild cognitive Impairment

Trauma

Depression

Late onset Schizophrenia

Amnesic syndrome

Learning Difficulty

Substance misuse

Drug side effects

37
Q

Areas of impairment in dementia

A

My cat loves eating pigeons

Memory
Cognition
Language
Executive function
Personality

38
Q

3 things that contribute to dementia

A

The three Ds

depression
drugs
delirium

39
Q

Requirements for capacity

A

*understand the information that is relevant to the decision they want to
make

*retain the information long enough to be able to make the decision

*weigh up the information available to make the decision

*communicate their decision by any possible means, including talking, using
sign language, or through simple muscle movements such as blinking an
eye or squeezing a hand.

40
Q
A

Psychiatry (17 decks)

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