Organic reactions Flashcards
What is an organic reaction
Delirium and dementia
What is an acute organic reaction?
Delirium
What is delirium?
Sudden onset of confusion or psychosis caused by a physical condition
What is the most common form of psychosis seen in hospitals?
Delirium
What are some predisposing factors for developing delirium?
Extremes of age
Brain damage- Dementia, head injury, alcohol, stroke
Unfamiliar environment
Sleep deprivation
What are some categories of underlying disease that can cause delirium?
Systemic Metabolic Vitamin deficiencies Endocrine disorders Intracranial pressure Epilepsy Drug intoxication Drug/alcohol withdrawal Post op
What systemic conditions can cause delirium?
Any that cause high pyrexia- malaria
What metabolic conditions can cause delirium?
Hepatic failure
Renal failure
Dehydration
Electrolyte imbalance
What are some vitamin deficiencies can cause delirium?
Thiamine/B1- Beriberi
Nicotinic acid/B3- Pellagra
Vitamin B12
What endocrine conditions can cause delirium?
Hypothyroidism
Cushing’s syndrome
What intracranial conditions can cause delirium?
SOL
What drug intoxication can cause delirium?
Anticolinergice Parkinson drugs Digoxin DA TCA Anticonvulsants Antimuscarinics
What is a major drug whose withdrawal can cause delirium?
Bzd
What are some symptoms of delirium?
Clouding of consciousness Disturbance of cognition Confusion- worse at night Sleep reversal Incoherent thought and speech Persecutory delusions
What is the time scale of delirium onset?
Hours to days
How do the symptoms of delirium progress?
Fluctuate
How long does delirium last for?
Days to months but usually resolve in 1-4 weeks
What is clouding of consciousness?
Drowsiness
Decreased awareness of surroundings
Distractibility
What is disturbance of cognition?
Disorientation
Impaired memory
Visual hallucinations/illusions
What is a major diagnostic criteria for a delirium diagnosis?
Clouding of consciousness
What are some complications of delirium?
Uncooperative Restless Agitated Frightened Irritability
What is the differential for delirium?
Delirium Tremens
Lewy body dementia
How do you treat delirium?
Treat underlying cause
Pharma- antipsychotics and bzd
What is the first line pharma treatment for delirium?
Antipsychotics (haloperidol)
Don’t use in Lewy Body dementia
Should bzd routeinly be given in delirium?
No! Only give as last resort
Which two bzd are occasionally used in delirium?
Diazepam
Lorazepam
What is diazepam used for in delirium?
Alcohol withdrawal
What is lorazepam used for in delirium?
Parkinson’s
Lewy body dementia
What can delirium progress to?
Dementia
What is a chronic organic reaction?
Dementia
What is dementia?
Acquired progressive impairment of cognition that interferes with social functioning but without clouding of consciousness
How long must the symptoms be present for dementia to be diagnosed?
6 months
What are some symptoms of dementia?
Personality changes- Aggression, Disinhibition Behavioral changes- Wandering Focal neurological signs Psychotic symptoms Lack of insight
What personality changes are associated with dementia?
Aggression
Disinhibition
What behavioural changes are associated with dementia?
Wandering
What are some pathologies of dementia?
Alzheimer’s
Vascular
Lewy body
Other
What is a variation of dementia?
Mild cognitive impairment
What is Mild cognitive impairment?
Decline in cognitive function that’s not bad enough to be dementia.
What can mild cognitive impairment progress to?
Dementia
How do you diagnose dementia?
Mini Mental State Exam
What numbers on the MMSE dictate dementia?
> 27/30 excludes dementia
<24/30 supports dementia
What three categories of dementia are there and what MMSE scores do they correspond to?
Mild: 21-26
Moderate: 11-20
Severe: <10
What is the differential for dementia?
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
How do you manage dementia?
Palliate
Treat symptoms
SSRI for depression
Avoid antipsychotic medication
How do you treat symptoms in dementia?
Exercise for wandering
Incontinence etc
Risperidone for aggression
What form of dementia must you never give antipsychotics to?
Lewy body
What two drug classes can be used to help Alzheimer’s?
Cholinesterase inhibitors- Donepezil
NMDA antagonist- Memantine
Give an example of a cholinesterase inhibitor
Donepezil
Give an example of an NMDA antagonist
Memantin
What is donepezil?
Cholinesterase inhibitor
What is memantin?
NMDA antagonist
What are some side effects of donepezil?
Increase risk of falls
Bradycardia
GI bleed
How long is average life expectancy after dementia diagnosis?
5-8 years
