Organic disorders (delirium)

Question 1

What is an organic mental disorder?

Answer 1

A dysfunction of the brain which is not caused by a psychiatric condition.

Question 2

What are examples of organic mental disorders?

Answer 2

Delirium
Dementia
Alzheimers
Amnesia

Question 3

What are acute/temporary (mostly) organic disorders?

Answer 3

Delirium
Organic mood disorder
Organic psychotic disorder

Question 4

What are chronic/longer term organic disorders?

Answer 4

Dementia
Amnesic syndrome
Organic personality change

Question 5

What is delirium?

Answer 5

A nonspecific syndrome characterised by disturbances of consciousness, attention, perception, thinking, memory, psychomotor behaviour, emotion and the sleep wake cycle.

Question 6

What are the signs of delirium?

Answer 6

Impaired consciousness and attention
Delusions
Dysgraphia 
Hallucinations 
Hyper/hypoactive (hypo more common)
Disturbed sleep-wake cycle
Emotional disturbance 
Rapid onset
Diurnally fluctuating Duration <6 months

Question 7

What is flocculation?

Answer 7

Patients picking at objects that aren’t there

Question 8

What is carphology?

Answer 8

Aimlessly picking at bedcloths

Question 9

What are the main differences between delirium and dementia?

Answer 9

Delirium: 
Acute onset
Fluctuating with lucid periods 
No atrophy on CT
Lasts hours to weeks 
Disorganised and delusional thinking 
High or low alertness

Dementia: 
Insidious onset
Stable throughout the day
lasts months to years 
Normal alertness
Normal sleep-wake cycle
Difficulty in word finding

Question 10

What is the prognosis of delirium?

Answer 10

20% die during their admission

50% die at 1 yr

Question 11

what is the treatment for delirium?

Answer 11

Avoid sedation unless required to maintain safety

Question 12

Which medications can worsen/lengthen delirium?

Answer 12

Benzodiazepines
Promethazine
Antipsychotics

Question 13

What are the main signs and symptoms of delirium?

Answer 13

Disorientation
Hallucinations
Inattention
Memory problems
Change in mood or personality
Disturbed sleep

Question 14

What are common causes of delirium?

Answer 14

D - Drugs and Alcohol (Anti-cholinergics, opiates, anti-convulsants, recreational)
E - Eyes, ears and emotional
L - Low Output state (MI, ARDS, PE, CHF, COPD)
I - Infection
R - Retention (of urine or stool)
I - Ictal
U - Under-hydration/Under-nutrition
M - Metabolic (Electrolyte imbalance, thyroid, wernickes
(S) - Subdural, Sleep deprivation

Question 15

If patients with delirium are extremely agitated which medication should be used?

Answer 15

haloperidol or olanzapine