Organic Psychiatry

Question 1

Delirium Ix

Answer 1

Collateral Hx
MMSE (>24 is normal)
Physical exam (infection)
Blood:
FBC, WCC, neutrophils
CRP+ESR
U+E
Glucose
TFT and LFT
Ca
Folate and B12
VDRL
Urine dip and MSU
?CXR

Question 2

Delirium - cause

Answer 2

Manage aggravating factors (pain, dehydration, constipation)

stop unnecessary meds

Question 3

Behavioural Mx of delirium

Answer 3

Freq. reorientation
Good lighting
Sensory problems (glasses, hearing)
Avoid over/understimulation
Minimise change 
Remove things that could be tripped over
Silence unnecessary noises
Allow safe/supervised wondering
Refer to geri/psych

Question 4

Medication in delirium

Answer 4

Small nighttime dose of BZ can promote sleep

Short term sedation needed: low dose typical antipsych. (haloperidol) or BZ

Question 5

Preventing delirium

Answer 5

good sleep hygiene w/o meds
minimal movement around hospital
Encourage mobility
Proactive Mx of pain, dehydration, constipation

Question 6

Prognosis of delirium

Answer 6

A/w: mortality, more admissions, longer admissions, high readmission, subsequent nursing home replacement
May take days-weeks
some pts do NOT return to normal

Question 7

Normal pressure hydrocephalus Mx

Answer 7

VP shunt may allow CSF drainage

Question 8

Insomnia Mx

Answer 8

ID causes (mental/phys health, poor sleeo hygiene)
Advise against driving when sleepy
No screen before bed, caffeine etc
Only consider hypnotics if severe impairment:
- short term BZ or z-drug
- lowest effective dose for shortest duration
-r/v 2 weeks, ?CBT
SE: daytime sedation, poor motor coord, cognitive impairment, addiction