Organic psychiatric disorders

Question 1

8 Clinical features of delirium

Answer 1

1. Impairment of consciousness
2. Disorientation
3. Behaviour changes - hyperactive or hypo active
4. Thinking changes incl. delusions
5. Mood lability
6. Perception - typically visual hallucinations
7. Memory impairment
8. Insight impaired

Question 2

Causes of delirium

Answer 2

IWATCHDEATH
	Infection (either systemic or neurological)
	Withdrawal (drugs, alcohol)
	Acute metabolic disorder 
	Trauma or head injury
	CNS pathology 
	Hypoxia
	Deficiencies (B12, folic acid, thiamine)
	Endocrinopathies
	Acute vascular (shock, vasculitis, hypertensive encephalopathy)
	Toxins 
	Heavy metals (arsenic, lead, mercury)

Question 3

Prevalence of delirium

Answer 3

10-15% on medical ward

40-60% in ICU

Question 4

Aim of assessment of delirium

Answer 4

Find and treat the underlying cause

Question 5

Physical investigations for delirium

Answer 5

Bloods - FBC, urea and electrolytes, LFTs, TFTs, calcium, phosphate, magnesium, glucose, lactate, troponin, albumin, paracetamol and salicylate, haematinics (iron, folate, B12)
Blood and urine cultures
ABG
ECG
Urinalysis
Chest X-ray
Consider further tests such as CT head, lumbar puncture, EEG as indicated
MMSE or MOCA

Question 6

Management options for delirium

Answer 6

Treat the underlying medical cause
Reassurance and reorientation
Predictable and consistent routine
Avoid unnecessary medications
Explain to relatives and friends about delirium
Sleep - Can use zopiclone or benzodiazepines (controversial) to encourage sleep at night.
Low dose antipsychotics for disturbed, violent or distressed behaviour
○ Quetiapine/haloperidol, often IM

Question 7

Definition of dementia

Answer 7

Global and gradual decline of intellect, memory and personality without impairment of consciousness, resulting in impaired social and occupational functioning due to behaviour issues, language problems, mood lability and changes in perception

Question 8

Two typical clinical characteristics of dementia

Answer 8

uncharacteristic aggressive behaviour and sexual disinhibition