Delirium and mental status

Question 1

Aspects of Appearance

Answer 1

Physical appearance (hygiene)

Behavior (mannerisms and psychomotor retardation)

Attitude (cooperative? guarded?)

Question 2

Aspects of Behavior

Answer 2

Behavior (mannerisms and psychomotor retardation)

Question 3

Mood vs Affect?

Answer 3

Mood is the experienced emotion that the patient expresses

Affect is the emotion that the clinician observes the patient to express.

Question 4

Thought process vs Thought Content

Answer 4

Thought process is how the patient forms thinking. Whether patient’s thoughts are logical, goal directed etc. Pushed speech?Tangential? Loosening of Association? Word salad?

Thought Content is the types of ideas expressed. Delusions? Suicidal/homicidal thoughts phobias, compulsions, hallucinations, Illusions

Question 5

Hallucination vs illusion

Answer 5

Hallucinations are when a person senses/sees/hears something without external stimuli

Illusions are when there is a stimuli but there is an inappropriate interpretation (everyone’s face in an audience turning into the devil)

Question 6

questions to assess sensory and cognition perception

Answer 6

Memory: recent, recent past, remote

fund of knowledge

Attention: spell world backwards, subtract 7 from 100 a bunch

Reading: read simple sentences

Abstract: similarities between objects, meaning of proverbs

Question 7

Insight vs judgement vs reality testing

Answer 7

Insight is the patient’s awareness and understanding of dx. This could include denial or blaming dx on something else

judgement is ability to understand the outcome of his or her actions “what would you do if you smelled smoke in a crowded theater”

Question 8

Attention, behavior, cognition associated with delirium

Answer 8

ACUTE ONSET, VARIABLE THROuGHOUT THE DAY

Reduced clarity of awareness

reduced ability to focus, sustain or shift focus

change in cognition (memory deficity, disorientation language disturbance)

Development of perceptual disturbance

Question 9

Psychosis vs Delirium vs dementia

Answer 9

Delirium is not necessarily an organic process but results from anoxia which cause excess dopamine production, stimulates NT release as well as reduces reuptake of NTs from synapses so synaptic cleft is flooded with Dopamine

Question 10

Major causes of delirium

Answer 10

Intracranial disturbances (epilepsy, neoplasm in the temporal lobe)

Extracranial drugs (anticholinergics, anticonvulsants, steroids, opiates, sedatives, antihtns)

Posions (CO2, heavy metals)

Endocrine dysfunction

Organ disease (liver, kidney, CV, lung)

Thiamine, B12, folic acid deficiency

Systemic infection

Electrolyte imbalance

**Postoperative over 60yo especially **

Question 11

Medical disorders in delirium

Answer 11

Epiliepsy,

Question 12

Haloperidol is the pharmacological choice for delirium because?

Answer 12

It is a pure dopamine antagonist (it doesn’t have as many receptors on it, just binds dopamine as compared to risperidone which has more receptors )

Also is can be administered in many different ways.