OPMH Teaching (ppt as missed) Flashcards
Define delirium
- sometimes called ‘acute confusional state
- common clinical syndrome characterised by disturbed consciousness, cognitive function or perception
- Has an acute onset and fluctuating course.
- It usually develops over 1–2days.
- It is a serious condition that is associated with poor outcomes. However, it can be prevented and treated if dealt with urgently.
Signs/symptoms of delirium
- Impaired consciousness and attention
- Rapid onset
- Psychotic symptoms; usually visual hallucinations, transient delusions
- Disturbance of the sleep–wake cycle
- Emotional disturbance - depression, anxiety perplexity
- Disturbance of motor activity - both under and over-activity.
When does delirium often occur?
- General medical wards
- After hip fracture
- After stroke
Three types of delirium
- Hyperactive - heightened arousal, restless, agitated and aggressive (least common)
- Hypoactive - withdrawn, quiet and sleepy, underdiagnosed and misdiagnosed as depression. Longer hospital stay in this variant
- Mixed
Other 3 types of delirium
- Delirium superimposed on dementia - common as dementia is strong RF
- Persistent - several weeks-months
- Subsyndromal delirium (SSD) - one or more but not all symptoms of delirium. Associated with lower cognitive function, increased hospital stay and decreased post discharge survival at 12 months
Define dementia
- Range of cognitive and behavioural symptoms that can include memory loss, problems with reasoning and communication and change in personality
- And a reduction in a person’s ability to carry out daily activities, such as shopping, washing, dressing and cooking.
ICD 10 dementia diagnosis features
- 6 months or more.
- A decline in memory.
- A decline in other cognitive abilities.
- Preserved awareness of the environment (i.e. absence of clouding of consciousness).
- A decline in emotional control, motivation or changes in social behaviour.
Alzheimers disease - parietotemporal features
- Aphasia
- Agnosia
- Apraxia
- Apathy
Frontal Alzheimers disease symptoms
- Irritability
- Disinhibition
Scoring vascular dementia
Hachinski ischaemic score 1974
Hachinski ischaemic score
- Abrupt onset (2)
- Stepwise deterioration (1)
- Fluctuating (2)
- Nocturnal confusion (1)
- Preserved personality (1)
- Depression (1)
- Somatic complaints (1) - excessive thoughts about symptoms eg pain
- Emotional incontinence (1)
- RF for vascular disease (eg hypertension(1), stroke(2), atherosclerosis(1))
- Focal neurological symptoms (2) or signs (2)
Score of 4 = AD or other dementia (non vascular)
Score of 7.= VaD
Dementia with Lewy Bodies core features - two needed for probable diagnosis, one needed for possible
- A. Fluctuating cognition with pronounced variations in attention and alertness.
- B. Recurrent visual hallucinations which are typically well- formed and detailed.
- C. Spontaneous motor features of parkinsonism.
Supportive features of Lewy Body dementia
- Repeated falls
- Syncope
- Transient LOC
- Neuroleptic sensitivity
- Systematized delusions
- Hallucinations in other modalities
Investigations for someone presenting with mood disturbance
- Routine bloods - FBC, LFT, U&E, glucose, lipids, B12, folate, calcium, phosphate, magnesium
- Urine dip for blood
- ECG
- CXR
- CT head
Confusion assessment method (CAM) for delirium
- Acute onset and fluctuating
- Inattention
- Disorganised thinking
- Altered level of consciousness
If features 1 and 2 and either 3 OR 4 are present = CAM positive
4AT for delirium
- Alertness
- AMT4 - age, DOB, place, current year
- Attention - months of year backwards
- Acute change or fluctuating course
4 and above = ?delirium +/- cognitive impairment
1-3 = possible cognitive impairment
0 = unlikely
Non-pharmacological (environment) measures do’s and don’ts for delirium
