Organic Psychiatry

Question 1

What is delirium?

Answer 1

acute, transient, global organic disorder, resulting in impaired consciousness and attention

15-20% of all general admissions to hospital

*hyperactive, hypoactive and mixed

Question 2

What is hypoactive delirium?

Answer 2

40%
- lethargy, low motor activity, sleepiness
- goes unrecognised, most common
- confusion with depression

*consider in elderly apathetic, quiet and withdrawn

Question 3

What is hyperactive delirium?

Answer 3

25%
- agitation, irritability, restlessness, aggression
- hallucinations and delusions
- confused with functional psychoses

Question 4

What is mixed delirium?

Answer 4

35%
- both features co-exist

Question 5

What might cause delirium?

Answer 5

hypoxia: rest failure, MI, CCF, PE
endocrine: hyper and hypothyroid, hyper and hypoglycaemia, cushings
infection: pneumonia, UTI*, encephalitis, meningitis
stroke
nutritional deficiencies
others: pain, sensory deprivation, relocation, lack of sleep
theatre: post anaesthesia, opiates, post-op complications
alcohol and drugs
GI: faecal impaction, retention

*most common

Question 6

What are the clinical features of delirium?

Answer 6

disordered thinking
euphoric
language impaired
hallucinations and delusion
inattention
disorientated
memory deficits

Question 7

How might delirium be investigated?

Answer 7

ABC
vitals: sats, pulse, BP, temp, CBG and O2
nutrition and hydration
CVS, Resp, abd exam and neuro
bloods: U&E, FBC, CRP, LFT, TFT
ECG, CXR, urine dip, ABG, CT head, EEG
*collateral Hx

Question 8

How would you manage delirium?
(NICE)

Answer 8

treat underlying cause
reassure and reorientate
provide appropriate environment
manage disturbed and violent behaviour