Organic reactions

Question 1

What is an organic reaction

Answer 1

Delirium and dementia

Question 2

What is an acute organic reaction?

Answer 2

Delirium

Question 3

What is delirium?

Answer 3

Sudden onset of confusion or psychosis caused by a physical condition

Question 4

What is the most common form of psychosis seen in hospitals?

Answer 4

Delirium

Question 5

What are some predisposing factors for developing delirium?

Answer 5

Extremes of age
Brain damage- Dementia, head injury, alcohol, stroke
Unfamiliar environment
Sleep deprivation

Question 6

What are some categories of underlying disease that can cause delirium?

Answer 6

Systemic
Metabolic
Vitamin deficiencies
Endocrine disorders
Intracranial pressure
Epilepsy
Drug intoxication
Drug/alcohol withdrawal
Post op

Question 7

What systemic conditions can cause delirium?

Answer 7

Any that cause high pyrexia- malaria

Question 8

What metabolic conditions can cause delirium?

Answer 8

Hepatic failure
Renal failure
Dehydration
Electrolyte imbalance

Question 9

What are some vitamin deficiencies can cause delirium?

Answer 9

Thiamine/B1- Beriberi
Nicotinic acid/B3- Pellagra
Vitamin B12

Question 10

What endocrine conditions can cause delirium?

Answer 10

Hypothyroidism

Cushing’s syndrome

Question 11

What intracranial conditions can cause delirium?

Answer 11

SOL

Question 12

What drug intoxication can cause delirium?

Answer 12

Anticolinergice
Parkinson drugs
Digoxin
DA
TCA
Anticonvulsants
Antimuscarinics

Question 13

What is a major drug whose withdrawal can cause delirium?

Answer 13

Bzd

Question 14

What are some symptoms of delirium?

Answer 14

Clouding of consciousness
Disturbance of cognition
Confusion- worse at night
Sleep reversal
Incoherent thought and speech
Persecutory delusions

Question 15

What is the time scale of delirium onset?

Answer 15

Hours to days

Question 16

How do the symptoms of delirium progress?

Answer 16

Fluctuate

Question 17

How long does delirium last for?

Answer 17

Days to months but usually resolve in 1-4 weeks

Question 18

What is clouding of consciousness?

Answer 18

Drowsiness
Decreased awareness of surroundings
Distractibility

Question 19

What is disturbance of cognition?

Answer 19

Disorientation
Impaired memory
Visual hallucinations/illusions

Question 20

What is a major diagnostic criteria for a delirium diagnosis?

Answer 20

Clouding of consciousness

Question 21

What are some complications of delirium?

Answer 21

Uncooperative
Restless
Agitated
Frightened
Irritability

Question 22

What is the differential for delirium?

Answer 22

Delirium Tremens

Lewy body dementia

Question 23

How do you treat delirium?

Answer 23

Treat underlying cause

Pharma- antipsychotics and bzd

Question 24

What is the first line pharma treatment for delirium?

Answer 24

Antipsychotics (haloperidol)

Don’t use in Lewy Body dementia

Question 25

Should bzd routeinly be given in delirium?

Answer 25

No! Only give as last resort

Question 26

Which two bzd are occasionally used in delirium?

Answer 26

Diazepam | Lorazepam

Question 27

What is diazepam used for in delirium?

Answer 27

Alcohol withdrawal

Question 28

What is lorazepam used for in delirium?

Answer 28

Parkinson's | Lewy body dementia

Question 29

What can delirium progress to?

Answer 29

Dementia

Question 30

What is a chronic organic reaction?

Answer 30

Dementia

Question 31

What is dementia?

Answer 31

Acquired progressive impairment of cognition that interferes with social functioning but without clouding of consciousness

Question 32

How long must the symptoms be present for dementia to be diagnosed?

Answer 32

6 months

Question 33

What are some symptoms of dementia?

Answer 33

``` Personality changes- Aggression, Disinhibition Behavioral changes- Wandering Focal neurological signs Psychotic symptoms Lack of insight ```

Question 34

What personality changes are associated with dementia?

Answer 34

Aggression | Disinhibition

Question 35

What behavioural changes are associated with dementia?

Answer 35

Wandering

Question 36

What are some pathologies of dementia?

Answer 36

Alzheimer's Vascular Lewy body Other

Question 37

What is a variation of dementia?

Answer 37

Mild cognitive impairment

Question 38

What is Mild cognitive impairment?

Answer 38

Decline in cognitive function that's not bad enough to be dementia.

Question 39

What can mild cognitive impairment progress to?

Answer 39

Dementia

Question 40

How do you diagnose dementia?

Answer 40

Mini Mental State Exam

Question 41

What numbers on the MMSE dictate dementia?

Answer 41

>27/30 excludes dementia | <24/30 supports dementia

Question 42

What three categories of dementia are there and what MMSE scores do they correspond to?

Answer 42

Mild: 21-26 Moderate: 11-20 Severe: <10

Question 43

What is the differential for dementia?

Answer 43

Deafness or dysphasia Depression Delirium Transient global amnesia Other psychiatric disorder (especially late onset schizophrenia or psychosis) Drugs (especially those with anticholinergic effects, can exacerbate any cognitive impairment) Epilepsy

Question 44

How do you manage dementia?

Answer 44

Palliate Treat symptoms SSRI for depression Avoid antipsychotic medication

Question 45

How do you treat symptoms in dementia?

Answer 45

Exercise for wandering Incontinence etc Risperidone for aggression

Question 46

What form of dementia must you never give antipsychotics to?

Answer 46

Lewy body

Question 47

What two drug classes can be used to help Alzheimer's?

Answer 47

Cholinesterase inhibitors- Donepezil | NMDA antagonist- Memantine

Question 48

Give an example of a cholinesterase inhibitor

Answer 48

Donepezil

Question 49

Give an example of an NMDA antagonist

Answer 49

Memantin

Question 50

What is donepezil?

Answer 50

Cholinesterase inhibitor

Question 51

What is memantin?

Answer 51

NMDA antagonist

Question 52

What are some side effects of donepezil?

Answer 52

Increase risk of falls Bradycardia GI bleed

Question 53

How long is average life expectancy after dementia diagnosis?

Answer 53

5-8 years