Delirium and Emergency Psychiatry - McIntyre

Question 1

delirium

Answer 1

MC elderly man in ICU

Question 2

encephalopathy

Answer 2

delirium

acute brain failure

ICU psychosis

cerebral insufficiency

Question 3

medical emergency

Answer 3

delirium

need to tx underlying cause

Question 4

delirium

Answer 4

neuropsych syndrome
-specific cause

wax and wane
acute onset
hypoactive, hyperactive, mixed
withdrawal and non-withdrawal

Question 5

delirium vs. dementia

Answer 5

dementia - neurocognitive disorder

dementia - progressive decline

delirium - acute onset

Question 6

disease of disrupted attention

Answer 6

delirium

Question 7

waxing and waning

Answer 7

in delirium

not dementia - except DLB - lewy body

Question 8

vital sign disturbance

Answer 8

delirium

also - sleep wake cycle messed up

Question 9

test of attention

Answer 9

serial 7

Question 10

risk with delirium

Answer 10

risk fx for developing dementia

cause long term cognitive decline

Question 11

poor prognosis

Answer 11

delirium

20-40% mortality next 12 months

Question 12

NT in delirium

Answer 12

decreased ACh
increased DA
and others

Question 13

causes of delirium

Answer 13

metabolic
meds
infections
intox/withdarwal
cerebrovasc disease
pulmonary disease
CV disease
head trauma 
burns

Question 14

tx of delirium

Answer 14

treat underlying cause

stop anticholinergic meds

low dose haloperidol

can increase QT interval - and decrease seizure threshold

Question 15

anticholinergic meds

Answer 15

stop them with delirium

Question 16

.no benzos

Answer 16

in delirium

-except alcohol/benzo withdrawal

Question 17

olanzapine, clozapine, chlorpromazine

Answer 17

anticholinergic antipsychotics

do not give with delirium

Question 18

prevention of delirium

Answer 18

sensory equip ok

encourage sleep cycle - melatonin

Question 19

risk fx of violence

Answer 19

best predictor - previous hx of violence

hallucinations
stated desire harm others
antisocial/borderline
substance use
delirium
major mild dementia
head trauma

Question 20

management of violence

Answer 20

empathy
eye contact
validate pt feelings
enforce boundaries
body language
listening > talking

Question 21

management of violent patient

Answer 21

safely escort pt to seclusion area
administer meds if necessary

physical restraints removed as soon as possible**

can never use restraints as punishment

restraints can lead to death - rhabdomyolysis, suffocation

Question 22

always ask about

Answer 22

suicide

hospitalize against will if necessary

Question 23

85% people at end of life

Answer 23

delirius