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Psychiatry > Organic reactions > Flashcards

Organic reactions Flashcards

1
Q

What is an organic reaction

A

Delirium and dementia

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2
Q

What is an acute organic reaction?

A

Delirium

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3
Q

What is delirium?

A

Sudden onset of confusion or psychosis caused by a physical condition

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4
Q

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

A

Delirium

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5
Q

What are some predisposing factors for developing delirium?

A

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

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6
Q

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

A 
Systemic
Metabolic
Vitamin deficiencies
Endocrine disorders
Intracranial pressure
Epilepsy
Drug intoxication
Drug/alcohol withdrawal
Post op
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7
Q

What systemic conditions can cause delirium?

A

Any that cause high pyrexia- malaria

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8
Q

What metabolic conditions can cause delirium?

A

Hepatic failure
Renal failure
Dehydration
Electrolyte imbalance

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9
Q

What are some vitamin deficiencies can cause delirium?

A

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

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10
Q

What endocrine conditions can cause delirium?

A

Hypothyroidism

Cushing’s syndrome

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11
Q

What intracranial conditions can cause delirium?

A

SOL

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12
Q

What drug intoxication can cause delirium?

A 
Anticolinergice
Parkinson drugs
Digoxin
DA
TCA
Anticonvulsants
Antimuscarinics
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13
Q

What is a major drug whose withdrawal can cause delirium?

A

Bzd

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14
Q

What are some symptoms of delirium?

A 
Clouding of consciousness
Disturbance of cognition
Confusion- worse at night
Sleep reversal
Incoherent thought and speech
Persecutory delusions
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15
Q

What is the time scale of delirium onset?

A

Hours to days

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16
Q

How do the symptoms of delirium progress?

A

Fluctuate

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17
Q

How long does delirium last for?

A

Days to months but usually resolve in 1-4 weeks

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18
Q

What is clouding of consciousness?

A

Drowsiness
Decreased awareness of surroundings
Distractibility

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19
Q

What is disturbance of cognition?

A

Disorientation
Impaired memory
Visual hallucinations/illusions

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20
Q

What is a major diagnostic criteria for a delirium diagnosis?

A

Clouding of consciousness

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21
Q

What are some complications of delirium?

A 
Uncooperative
Restless
Agitated
Frightened
Irritability
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22
Q

What is the differential for delirium?

A

Delirium Tremens

Lewy body dementia

23
Q

How do you treat delirium?

A

Treat underlying cause

Pharma- antipsychotics and bzd

24
Q

What is the first line pharma treatment for delirium?

A

Antipsychotics (haloperidol)

Don’t use in Lewy Body dementia

25
Q

Should bzd routeinly be given in delirium?

A

No! Only give as last resort

26
Q

Which two bzd are occasionally used in delirium?

A

Diazepam

Lorazepam

27
Q

What is diazepam used for in delirium?

A

Alcohol withdrawal

28
Q

What is lorazepam used for in delirium?

A

Parkinson’s

Lewy body dementia

29
Q

What can delirium progress to?

A

Dementia

30
Q

What is a chronic organic reaction?

A

Dementia

31
Q

What is dementia?

A

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

32
Q

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

A

6 months

33
Q

What are some symptoms of dementia?

A 
Personality changes- Aggression, Disinhibition
Behavioral changes- Wandering
Focal neurological signs
Psychotic symptoms
Lack of insight
34
Q

What personality changes are associated with dementia?

A

Aggression

Disinhibition

35
Q

What behavioural changes are associated with dementia?

A

Wandering

36
Q

What are some pathologies of dementia?

A

Alzheimer’s
Vascular
Lewy body
Other

37
Q

What is a variation of dementia?

A

Mild cognitive impairment

38
Q

What is Mild cognitive impairment?

A

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

39
Q

What can mild cognitive impairment progress to?

A

Dementia

40
Q

How do you diagnose dementia?

A

Mini Mental State Exam

41
Q

What numbers on the MMSE dictate dementia?

A

> 27/30 excludes dementia

<24/30 supports dementia

42
Q

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

A

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

43
Q

What is the differential for dementia?

A

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

44
Q

How do you manage dementia?

A

Palliate
Treat symptoms
SSRI for depression
Avoid antipsychotic medication

45
Q

How do you treat symptoms in dementia?

A

Exercise for wandering
Incontinence etc
Risperidone for aggression

46
Q

What form of dementia must you never give antipsychotics to?

A

Lewy body

47
Q

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

A

Cholinesterase inhibitors- Donepezil

NMDA antagonist- Memantine

48
Q

Give an example of a cholinesterase inhibitor

A

Donepezil

49
Q

Give an example of an NMDA antagonist

A

Memantin

50
Q

What is donepezil?

A

Cholinesterase inhibitor

51
Q

What is memantin?

A

NMDA antagonist

52
Q

What are some side effects of donepezil?

A

Increase risk of falls
Bradycardia
GI bleed

53
Q

How long is average life expectancy after dementia diagnosis?

A

5-8 years

Psychiatry (22 decks)

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