Intro (delirium + Stigma) Flashcards
What are persecutory delusions?
Delusions about you and putting yourself under threat
What is adjustment reaction?
A condition where patients will feel “states of subjective distress and emotional disturbance arising in the period of adaptation to a significant life change of a stressful life event”
Symptoms: Depressed mood Anxiety Can’t cope or plan ahead Some disability in the performance of daily routine
Eg. Moving to a care home
What is organic delusional disorder?
Persistent or recurrent delusions dominate the clinical picture
Delusions may be accompanied by hallucinations
Features of schizophrenia (bizarre hallucinations, thought disorder) may be present
What is the epidemiology of post stroke psychosis?
Delusions in 4.67% of people
Hallucinations in 5.05%
Occurs more after right hemisphere strokes 5:1
Common delusional themes:
Persecutory
Jealousy
Environment
Not really any treatment options
What are the relationships between mental and physical and mental illness?
30% of people with a long term health condition have a mental health problem
46% of people with a mental health problem have a long term health condition
20% of the population of England have a mental health condition
Eg might physical illness cause mental illness and vice versa?
Mental->physical:
Chronic stress can cause physical problems
Mental health drugs can increase CVD
Poor lifestyle choices (more likely to smoke, alcohol, drugs)
Access to care
Diagnostic overshadowing (focus on mental illness, don’t get to root of problem)
Physical-> mental :
People may not be able to work Or do hobbies
Social circle lessens
Some medication (steroids eg) can cause mental problems
What are some examples of physical illness that have possible mental health symptoms?
Cardiovascular disease - 3x risk of depression and anxiety
Diabetes - 2x risk of depression
COPD - 10x risk of panic disorder
MSK disorders - 2x risk of depression
Cushing’s - depression
Syphillis, HIV - psychosis
What factors may affect timely diagnosis of a physical disorders in people with mental illness?
Illness behaviour
Diagnosis overshadowing (doctors can’t look past the mental)
Stigma
Lack of resources
What are some methods of cognitive examination/screening?
Abbreviated mental test score
Montreal cognitive assessment - this is a better screening tool, it has a higher sensitivity
What is delirium?
Organic cerebral syndrome characterised by concurrent disturbances of consciousness and attention, perception, thinking, memory, psychomotor behaviour, emotion and sleep wake schedule
Aka - acute confusion all state
Duration is variable
Severity varies from mild to severe
What is the prevalence of delirium?
20% of actute hospital patients >65 on admission
20% more develop delirium after admission
Overall prevalence 30% on wards, 80% in intensive care
50% undetected
It delays discharge and increases mortality by up to 40%
What are some possible causes of delirium?
Infection (UTI, pneumonia, etc) Change in environment Medication Alcohol withdrawal Surgery Pain Liver/renal impairment Hypoxia Hyponatremia! Stroke Encephalitis Constipation! Urine retention Dehydration
What are some predisposing factors of delirium?
Advanced age Dementia (may be undetected) Impaired activities of daily living Immobility Sensory impairment Urinalysis catheterisation Malnutrition Alcohol Depression
How is delirium managed?
Anticipate it Modify risk factors if possible Early diagnosis Treat the causes Good nursing Medication (but not that effective) Wait!
What are some symptoms and presentation of delirium?
Sudden onset Fluctuating (may be worse at night) confusion and Inattention Disorientation Possible aggression Hallucination
