Dementia/delerium/sleep disorders/health anxiety disorders Flashcards
Delirium
general and Sx
- waxing & waning level of consciousness w/ rapid onset
- rapid decrease in attention span + level of arousal
- key sx: disorganized thinking, hallucinations (often visual), sleep disturbances, cognitive dysfunction, agitation
Delirium
Screening
- clinical
- EEG: abrnomal in delerium (normal in dementia)
CRAM
- evalates for 4 fundamental features of delerium
- acute onset & fluctuating course, inattention, disorganized thinking, or altered LOC
Delirium
Tx
- correct underlying cause (tx infection, assisted withdrawal)
- maintain O2 levels, treat pain, maintain hydration
- calm, quiet environment for recovery
- Haloperidol (PRN- tx psychotic symptoms)
Delirium
Pearls
What to avoid
- reversible (esp anti-cholinergics)
- usually secondary to other illness or stressors (CNS diseases, infection, trauma, substance abuse/withdrawal)
on boards: often is post-op development of fever w/ associated infection
avoid benzodiazepines, can worsen psychotic sx
Dementia
General and Sx
- progressive decline in cognition and motor function w/ normal level of consciousness
- key sx: memory loss/deficits, impaired judgement, personality changes, loss of motor function (late stages)
- seen in elderly pts
- irreversible disease progress
Types
- Alzheimer’s (60%)
- Infarction (20%- caused by stroke)
- Lewy Body (Parkinson Disease)
Dementia
Dx
clinical (but screen for other causes of memory loss like depression, hypothyroidism, HIV, vitamin deficiencies)
Narcolepsy
general and Sx
- excessive daytime sleepiness despite being awake and well-rested
- hypnagogic hallucination (just before going to sleep) and hyponopompic hallucinations (just before awakening)
- sleep paralysis (nocturnal & narcoleptic sleep episodes that begin w/ REM sleep)
- cataplexy (loss of all msk tone following strong emotional stimuli)
Narcolepsy
Criteria
- recurrent episodes of rapid onset, overwhelming sleepiness >3x wkly for the last 3 mo
- due to decreased orexin (hypocretin) production in lateral hypothalamus & dysregulated sleep-wake cycles
Narcolepsy
Tx
good sleep, daytime stimulants (amphetamines) or nighttide sodium oxybate (GHB)
Modafinil: non-amphetamine CNS stimulant to promote wakefulness (first line)
Stages of sleep
lack of sleep can cause exhaustion, drowsiness, axnxiety, depression, physiological impacts (cardiac, metabolic)
Stages
N1: lightest; theta waves; least amount of sleep occurs here
N2: medium; theta complexes (K-complexes + sleep spindle); bruxism (teeth grinding); largest percentage of sleep
N3: deepest sleep; delta waves; sleep walking, enuresis occurs here; night terrors
REM: dreams/nightmares; sawtooth pattern; penile tumescence
Cycles: NREM cycle is usually 90min; more cycles = longer REM
Sleep Terror Disorder
general and Sx
periods of inconsolable terror w/ screaming in the middle of the night
no memory of arousal episode
Sleep Terror Disorder
triggers
emotional stress, fever, lack of sleep
Sleep Terror Disorder
Tx
usually self limiting
Malingering Disorder
general
fake/exaggerate sx
consciously falsified medical symptoms
usually done for secondary external gain (worker’s compensation, opioids)
watch for poor compliance w/ tx or follow up of dx tests
malingering
Tx
ends when secondary gain is achieved
Munchausen Syndrome/Factitious Disorder
fake/exaggerated sx
Key: frequent stays in hospital, reluctance to allow Drs to talk to friends/families, conditions worsening despite tx or for no reason, inconsistent sx, extensive knowledge of medical terms/diseases
- by proxy: fake/exaggerated sx imposed on others (caregiver falsifies medical sx) ABUSE; MANDATORY REPORT
- factitious disorder imposed on self
- unconsciouslly falsified medical symptoms
Risk Factors: female gender, unmarried, prior or current HCP
Munchausen Syndrome/Factitious Disorder
Tx
NOT SELF LIMITING (usually have significant hx of getting medical tx)
Somatic Symptom Disorders
general
present for 6+ mo
1+ physical sx that cause distress (but normal HPI/PE)
can lead to dysfunctional thoughts, feelings, or behaviors associated w/ physical sx (like MDD)
can co-occur w/ medical illnes
unconscious, unintentional sx
Risk Factors: female gender, lower SES, lower education, ethnic minority
Somatic Symptom Disorders
Tx
regular office visits w/ same PCP along with psychotherapy
Pain Disorder
General
characterized by chronic pain causing significant distress or impairment
psychologic factors appear to worsen pain
unconscious, unintentional sx
Risk Factors: female gender, lower SES, lower education, ethnic minority
Pain Disorder
tx
regular office visits w/ same PCP along with psychotherapy
Illness Anxiety Disorder
general
present for 6+ mo
hypocondriasis
excessive care/worry about having or acquiring a serious illness leading to dysfunctional behaviors associated w/ health
constant check ups
minimal somatic sx (no physical findings)
unconscious, unintentional sx
Risk Factors: female gender, lower SES, lower education, ethnic minority
Illness Anxiety Disorder
Tx
regular office visits w/ same PCP along with psychotherapy
Conversion Disorder
general
Functional Neurologic Symptom Disorder
loss of sensory/motor function w/out affecting day to day function (paralysis, blindness, mutism, seizures)
often follows acute stressors
la belle indifference (indifferent to the loss of sensory/motor function, so does not affect day to day function)
unconscious, unintentional sx
Risk Factors: female gender, lower SES, lower education, ethnic minority
Conversion Disorder
tx
regular office visits w/ same PCP along with psychotherapy
