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YEAR 4 MENTAL HEALTH > "Physical (organic) disorders presenting with psychological and/or behavioural disturbance (e.g. delirium)" > Flashcards

"Physical (organic) disorders presenting with psychological and/or behavioural disturbance (e.g. delirium)" Flashcards

1
Q

Name physical (organic) causes for a presenting complaint of:

Mood changes (depression/mania)

From Ox Handbook

A

MS
Stroke
DM
Brain tumour
Hypothyroidism

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2
Q

Name physical (organic) causes for a presenting complaint of:

Insomnia

From Ox Handbook

A

Sleep apnoea
Hyperthyroidism
GORD
Pain

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3
Q

Name physical (organic) causes for a presenting complaint of:

Insomnia

From Ox Handbook

A

Sleep apnoea
Hyperthyroidism
GORD
Pain

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4
Q

Name physical (organic) causes for a presenting complaint of:

Confusion/disorientation

From Ox Handbook

A

Renal failure
Cerebral arteritis
Sepsis

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5
Q

Name physical (organic) causes for a presenting complaint of:

Personality change

From Ox. Handbook

A

MS
Mass lesion
SLE
(i think FTDementia can do this too but not in book)

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6
Q

Name physical (organic) causes for a presenting complaint of:
Hallucinations

From Ox. Handbook

A

Migraine
Substance misuse
Encephalitis
Seizures

(LewyBodDem too i think - but not in book)

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7
Q

Name physical (organic) causes for a presenting complaint of:
Behavioural change

From Ox. Handbook

A

Vascular infarct
Lyme disease
Parkinson disease
Subdural haematoma
Mass lesion

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8
Q

Name physical (organic) causes for a presenting complaint of:
Psychosis

From Ox Handbook

A

Sensory loss
Syphilis
Dementia
Wilson’s disease
(substance misuse)

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9
Q

Name physical (organic) causes for a presenting complaint of:
Irritability

From Ox. Handbook

A

Vitamin B12 deficiency
Drug withdrawal (e.g. analgesics)
Substance misuse / withdrawal

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10
Q

Definition of delirium?

A
  • Fluctuating impaired consciousness
  • Onset is acute - over hours or days.
  • Causes disturbed consciousness, attention, cognition, and perception
  • There are 3 types - hyperactive, hypoactive and mixed delirium
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11
Q

What are predisposing factors for delirium?

NICE CKS

A
  • Older age (over 65 years).
  • Cognitive impairment (such as dementia).
  • Frailty/multiple comorbidities (such as stroke or heart failure).
  • Significant injuries such as hip fracture.
  • Functional impairment (for example immobility or the use of physical restraints such as cot sides).
  • Iatrogenic events (such as bladder catheterization, polypharmacy, or surgery).
  • History of, or current, alcohol excess.
  • Sensory impairment (such as visual impairment or hearing loss).
  • Poor nutrition.
  • Lack of stimulation.
  • Terminal phase of illness.
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12
Q

What are precipitating factors of delirium?

NICE CKS

A
  • Infection such as urinary tract infection, infected pressure sore, or pneumonia.
  • Metabolic disturbance such as hypoglycaemia, hyperglycaemia (including advanced carcinomatosis), or electrolyte abnormalities (including dehydration).
  • Cardiovascular disorders such as myocardial infarction or heart failure.
  • Respiratory disorders such as pulmonary embolism or exacerbation of chronic obstructive pulmonary disease.
  • Neurological disorders such as stroke, encephalitis, or subdural haematoma.
  • Endocrine disorders such as thyroid dysfunction or Cushing’s syndrome.
  • Urological disorders such as urinary retention.
  • Gastrointestinal disorders such as hepatic failure, constipation (including faecal impaction), or malnutrition.
  • Severe uncontrolled pain.
  • Alcohol intoxication or withdrawal.
  • Medications - (on another slide)
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13
Q

What medications can be precipitating factors for delirum?

A
  • Opioids
  • benzodiazepines (use and withdrawal),
  • dihydropyridines (such as amlodipine)
  • antihistamines (histamine-1 receptor antagonists)

Other drugs that have been associated with delirium include:
* dopamine agonists
* tricyclic antidepressants,
* lithium,
* antipsychotics,
* anticonvulsants,
* antiarrhythmics,
* antihypertensives,
* histamine-2 receptor antagonists,
* corticosteroids,
* NSAIDs

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14
Q

What psychosocial factors can precipitate delirium?

A
  • depression,
  • sleep deprivation,
  • visual or hearing impairment,
  • emotional stress,
  • change of environment
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15
Q

Prevalence of delirium?

A

1-2% in the community, with 14% in over 85s

For inpatients - up to 50% in over 65s

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16
Q

What are clinical features of delirium?

A

Acute change in behaviour
Symptoms fluctuate - worst disturbance at night
Behavioural changes:
* altered cognitive function (disorientated, worsened conc, slow responses, confusion)
* Inattention ( easily distractible, unable to maintain focus)
* Disorganised thinking (rambling, illogical flow of ideas)
* Altered perception (paranoid delusions, misperceptions, hallucinations)
* Altered physical function - hyperactive, hypoactive, mixed.
* altered social behaviour - changes in mood and emotions. inappropriate behaviour
* altered level of consciousness - drowsy, disturbed sleep, complete sleep cycle reversal.

17
Q

What are warning signs of delirium?

A

Falling
Loss of appetite

18
Q

Differential diagnosis for delirium?

A
  • withdrawal from drugs/alcohol
  • mania
  • depression
  • post-ictal
  • psychosis
  • anxiety
  • consider dementia - if insidious onset and have clear consciousness.
  • thyroid disease
  • Temporal lobe epilepsy or non-convulsive epilepsy
  • Charles Bonnet syndrome
19
Q

Causes of delirium

A
20
Q

What are causes of delirium?

A

see image. Also see pg 733 of Ox Handbook.

21
Q

What investigations would you do for a pt presenting with delirium?

A

Bloods: FBC, U+Es, ABG, Glucose, Blood cultures, LFTs
Bedside: MSU, ECG, LP
Imaging: CXR, CT

22
Q

How would you manage delirium?

A
  • Find precipitating cause and treat this.
  • Optimise supportive surroundings and nursing care
  • Avoid sedation unless they hve extreme agitation, risk or needed for investigations to take place. Give antipsychotics in 1st instance as benzos worsen delirium (apart from in alcohol withdrawal)
  • Haloperidol 1-10mg/24hrs or Olanzapine 2.5-10mg/24hrs
  • Regular review and follwo up.
23
Q

What are the 4As of Alzheimers?

A

Amnesia
Agnosia
Aphasia
Apraxia

24
Q

Define dementia?

A

Progressive and global intellectual deterioration without impairment of consciousness.

25
Q

What is the prevalence of dementia?

A

6% in over 65s
(NICE says it is 7.1%)

26
Q

What are reversible causes of dementia?

A

Subdural haematoma
Hydrocephalus
Hypothyroidism

27
Q

For more cards on delirium and dementia, see OPIC decks

A

yay

YEAR 4 MENTAL HEALTH (16 decks)

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