Old age psychiatry Flashcards
Definition of delirium
Acute, transient, global organic disorder of CNS.
Results in impaired consciousness and attention
Causes of delirium
Infection Hypoxia Post op Urinary retention or constipation Thiamine deficiency Severe pain Unfamiliar environment Lack of sleep Drugs
What drugs can cause delirium
Antidepressants Antipsychotics Benzodiazepines Anti Parkinson's drugs Opiates
CAM criteria
What score = delirium
Acute onset (2) Inattention (2) Disordered thinking (1) Impaired consciousness (1)
At least 5
ICD10 criteria for delirium
Impaired consciousness and attention Cognitive disturbance Psychomotor disturbance Emotional disturbance Disturbance of sleep wake cycle
Management of delirium
Treat underlying cause
Reorientate patient e.g face clock, give them a calendar, written information on where they are
Encourage visitors
Continuity of care
Avoid relocating
Monitor bowel movements and urine output
Avoid benzodiazepines (haloperidol for agitation)
Definition of dementia
Global impairment of memory, intellect and personality without impairment of consciousness
Leads to functional impairment (ADLs) and present for >6 months
Reversible causes of dementia
Normal pressure hydrocephalus Intracranial tumour Thiamine deficiency B12/folic acid deficiency Hypothyroidism Cushing's syndrome
Tests for dementia
MMSE
AMT
MOCA - Montreal cognitive assessment
Investigations to rule out organic causes of dementia like symptoms
FBC CRP U+Es LFTs Glucose Calcium TFTs B12 Folate
ICD10 criteria for dementia
Decline in memory Decline in cognitive function Decline in motivation or a change in social behaviour manifested by either: Emotional lability Irritability Apathy Coarsening of social behaviour
Management of dementia
BIOPSYCHOSOCIAL MODEL Home safety evaluation DVLA Advance planning - lasting power of attorney Acetylcholinesterase inhibitors Social support Home nursing
