Psych Dementia

Question 1

What is required for diagnosis of delirium?

Answer 1

Disturbance in attention and awareness that develops over a short period of time that fluctuates throughout the day.
Some disturbance in cognition.
Not better explained by something else
Evidence that the delirium is a direct effect of some medical issue

Question 2

What are the clinical characteristics of delirium?

Answer 2

fluctuating arousal
attention deficit
alterations in memory, language, construction, perception, and mood
Spontaneous speech may be incoherent, rambling, shifting topics.
Sleep disturbance

Question 3

What are some Agraphia and constructional ability symptoms associated with delirium?

Answer 3

illegible, abnormal spacing, agrammatical, spelling errors, omissions, distorted drawing.

Question 4

What are some Memory and learning ability symptoms associated with delirium?

Answer 4

unable to recall at 5 minutes

Question 5

What are some motor signs associated with delirium?

Answer 5

tremor, altered tone, asterixis, myoclonus, hyperreflexia

Question 6

What are some Executive function ability symptoms associated with delirium?

Answer 6

poor calculations, abnormal or intrusive associations, untroubled by discrepancies, perseverative

Question 7

What are some Psychosis symptoms associated with delirium?

Answer 7

Hallucination- usually fully formed visual

Question 8

How should delirium be managed?

Answer 8

Treat underlying cause (infection, electrolyte abnormalities, hypoglycemia, cardiac/pulmonary/hepatic/renal failure, endocrine, medications, drugs, withdrawal, trauma, epilepsy…)
Nutrition
Sleep
Electrolyte balance
Frequent re-orientation
Social and sensory stimulation
Use drugs sparingly and only when agitation is severe (Haldol, low dose atypicals, Donepezil, DO NOT GIVE benzos, physical restraints- avoid if at all possible)

Question 9

What are some of the negative consequences of delirium?

Answer 9

longer hospital stay, increased risk of death or disability, increased risk of future cognitive impairment, PTSD

Question 10

How do you distinguish delirium from dementia?

Answer 10

Dementia usually does not have an early disturbance of attention and arousal. Dementia starts with issues in higher executive function.

Question 11

What are the criteria for dementia?

Answer 11

Decline in cognitive abilities that affects daily living that is not better explained by another mental disorder.

Question 12

What are treatments for dementia?

Answer 12

Exercise, diet, cognitively stimulating activities, good sleep
Treat depression
Support and educate patient and caregivers
Address social and medical-legal issues