Organic Psychiatry Flashcards
What are the three types of delirium?
Hyperactive
Hypoactive
Mixed
What is hyperactive delirium?
hyper alert, agitated
What is hypoactive delirium?
Patient is drowsy, lethargic, withdrawn (can be missed)
What is the clinical presentation of delirium?
SUDDEN onset
Symptoms fluctuate, worse at night
Altered consciousness: drowsiness, stupor // hyperalert
Cognitive impairment: inattention, disorientation, poor memory, poor thinking (rambling)
Delusions and hallucinations
What is the management of delirium?
Treat cause and exacerbating factors
Stop unnecessary meds
Behavioural management (address sensory problems e.g. hearing aids, glasses, frequently reorientate with clocks, calendar, photos, good lighting)
What is the clinical presentation of Huntington’s?
Depression, euphoria, irritability, aggression
Chorea (limbs, trunk, face, speech muscle)
What are the three types of HIV associated neurocognitive disorder?
Asymptomatic cognitive impairment (ACI)
Mild neurocognitive disorder (MND)
Hiv Associated dementia (HAD)
What is Asymptomatic Cognitive Impairment?
30% of people with HIV
Person doesn’t notice problems, but formal testing shows cognitive deficit
What is Mild Neurocognitive Disorder?
Problems with memory, concentration, executive function, processing speed, motor difficulties
HIV Associated Dementia
Occurs with AIDS
Ataxia, tremor, seizure, myoclonus
What is the triad of symptoms with Normal Pressure Hydrocephalus?
DUI
Dementia
Unsteady gait
Incontinence of Urine
What are the two types of prion disease?
sCJD - sporadic
vCJD - from infected beef
What happens in prion disease?
Abnormal prion accumulation
20 years later, there is dementia, motor abnormality e.g. ataxia, myoclonus
Rapid deterioration > death
What are common psych symptoms with Parkinson?
depression
dementia
psychosis
what must you focus on when managing dementia
maintaining quality of life + preserving independence and dignity
what is delirium
acute confusional state with SUDDEN ONSET and FLUCTUATING
What are risk factors for delirium
old age pre-existing mental/physical illness esp dementia substance misuse polypharmacy nutrition poor
give causes of delirium
Vascular (stroke)
Infection(intracranial infection, septicaemia)
Trauma (head injury)
Metabolic (liver failure, renal failure, electrolyte imbalance, hypoglicaemia, Wenickes)
Inflammation (raised ICP)
Neoplasm
Drugs (intoxication, wtihdrawal, medications)
What investigations must you get for delirium
Physical exam
Collateeral history
Check drug chart
FBC, CRP, U&E, LFT, Calcium MSU, Oxygen sat (hypoxia is a cause) ECG CXR Septic screen
Explain aetiology of Huntington’s
Autosomal dominant
CAG repeat in Huntingtin gene (chr 4)
lengthening causes ANTICIPATION
Abnormal huntingtin protein causes atrophy of basal ganglia and thalamys and frontal lobe
what is anterograde memory loss
inability to lay down new memories from time of braind amage
what are causes of anterograde memory loss
hypoxia
encephalitis
carbon monoxide poisoning
KORSAKOFFs
Explain causes of frontal lobe syndrome
any type of damage to the frontal lobe
e.g. head injury, dementia, stroke
what are symptoms of frontal lobe syndrome
Executive duysfunction: poor judgement, poor reasoning, poor planning and decision making
Social behaviour and persolality change:
- loss of social awareness (irresponsible, disinhibited, inappropriade)
- impulsive
- euphoric
Apathy
- lack of motivation and initiative
- decline in self care
