Old Age Psychiatry Flashcards
Define Delirium
Acute transient global organic disorder of CNS resulting in impaired consciousness and attention
There are three types of delirium. Describe Hypoactive Delirium
Lethargy
Reduced motor activity
Apathy
Sleepiness
There are three types of delirium. Describe Hyperactive Delirium
Agitated
Aggressive
Hallucinations and Delusions
What is the third type of Delirium?
Mixed
There are many different causes of Delirium. Using the mnemonic THINk DELIRIUM, describe them
Trauma, Hypoxia, Increased age, NOF fracture, smoKer, Drugs, Environment, Lack of sleep, Imbalanced electrolytes, Retention, Infection, Uncontrolled Pain, Medical Conditions
Delirium is Acute in onset and fluctuating in course. Using the mnemonic DELIRIUM describe the classical presenting features
Disordered thinking, Euphoric, Language Impaired, Illusions (+/ - delusions or hallucinations), Reversal of sleep wake pattern, Inattention, Unaware (Disorientated), Memory Deficits
State the five ICD10 requirements for Delirium diagnosis
- Impairment of consciousness and attention
- Global disturbance in cognition
- Psychomotor disturbance
- Disturbance of sleep wake cycle
- Emotional disturbance
Name five immediate investigations you would do for a Delirious patient
Nutritional and Hydration Status Systems Examination Urinalysis Bloods (confusion screen) CXR
Describe the (10) features of an AMT (Abbreviated Mental Test)
Age, Time, (Recall 42 West Street at end), Year, Current Location, Identify two people, DOB, Date of WW1, Current Monarch, Count backwards from 20
Describe the features of CAM (Confusion Assessment Method)
Diagnosis involves the presence of 1 and 2 and 3/4
1) Acute Onset and Fluctuating Course
2) Inattention (demonstrated by serial 7s test)
3) Disorganised thinking (incoherent speech)
4) Altered consciousness
The mainstay of Delirium treatment is treating the underlying cause and providing reassurance. How can the patients environment be optimised?
Quiet
Well lit
Consistent staff
Encouraging visitation
How should the behaviour of Delirious patients be managed?
Medication should be a last resort
Oral low dose Haloperidol or Olanzepine
Avoid Benzodiazepines
Define Dementia
Generalised decline of memory, intellect and personality without impairment in consciousness leading to functional impairment
Name 4 irreversible causes of Dementia
Neurodegenerative
Infections (HIV, CJD)
Vascular
Traumatic Head Injury
Name 4 reversible causes of Dementia
Visual/Hearing impairment,
Nutritional Deficiencies
Normal pressure hydrocephalus
Hypothyroidism
What is Vascular Dementia?
Occurs as a result of Cerebrovascular Disease (stroke, multiple infarcts, or chronic changes such as Atherosclerosis)
What is Lewy Body Dementia?
Abnormal deposition of Lewy Body proteins throughout the cortex and brainstem
If outside brainstem - more profound cholinergic loss
If within brainstem - more profound dopaminergic loss and Parkinsonian sx