General Hospital Psychiatry and Somatisation

Question 1

delirium tremens symptoms

Answer 1

Often presents dramatically but may be a prodrome of insomnia, fearfulness, panic, nightmares
Vivid hallucinations
Delusions
Confusion
Tremor
Agitation
Sleeplessness
Autonomic overactivity
Impaired consciousness
EEG – fast activity

Question 2

how long does delirium tremens last for?

Answer 2

Usually lasts less than 72 hours
Recurrent phases may rarely occur over a longer period of time
On resolution of a prolonged attack, amnesic syndrome may remain
Likely due to unnoticed Wernicke’s encephalopathy

Question 3

what is mortality in delirium tremens?

Answer 3

cardiovascular collapse, infection, hyperthermia or self-injury

Question 4

Environmental and supportive measures

for delirium?

Answer 4

Education of relatives, medical and nursing staff
Make environment safe
Optimise stimulation
Orientation

Question 5

factors which can contribute to delirium?

Answer 5

Disorientation
Dehydration
Constipation
Hypoxia
Immobility/limited mobility
Infection
Multiple medications
Pain
Poor nutrition
Sensory impairment
Sleep disturbance

Question 6

meds for delirium

Answer 6

risperidone- antipsychotics

Lorazepam- benzodiazapine

Promethazine

Question 7

when to avoid antipsychotics in delirium?

Answer 7

Avoid antipsychotics in alcohol/drug withdrawal states unless patient well covered with benzodiazepines due to lowering of seizure threshold

Question 8

what are the associations with functional neurological diseases?

Answer 8

Approximately 2/3 patients with FND have past history of mental health problems.

History of adverse childhood
experiences/trauma may predispose to FND

psychological symptoms more common in functional neurological symptoms

Question 9

treatment for FND?

Answer 9

Explanation of FND
Medications for co-morbid mental health problems
Psychological therapies
CBT
Others including IPT and psychodynamic therapies
Other therapies for co-morbid disorders
i.e. OT for agoraphobia