psych ILAs Flashcards
define delirium
the clinical syndrome of fluctuating cognitive impairment associated with behavioural impairment
what might present with aggression?
*ETOH / drug intoxication or withdrawal Psychotic disorders (schizophrenia / mania) PDs delirium dementia stress adverse reaction to life events nb - pretty much anything
what are the common causes of delirium? (ie an acute confusional state)
acronym - DELIRIUM Drugs (eg. tcas / opiates / BDZs) Epilepsy / Electrolyte imbalance (hyperCa2+) Liver failure / Low O2 Infection Retention Intracranial Uraemia Metabolic (DM / thiamine / thyroid)
what symptoms and signs are associated with delirium (another acronym….)
CHAASM Cognitive hallucinations aggression agitation / abnormal thoughts sleep disturbance mood disturbance
what are the most common presentations of delirium?
Agitated (psychomotor agitation / increased arousal / delusions / hallucinations)
Hypoactive (big ddx for depression..) (psychomotor retardation / lethargy / xs somnolence)
Mixed
differential diagnoses of depression
- Major depressive disorder (CBT / antidepressants / ECT ?admit
- Mild to moderate depressive disorder
- Depression 2y to another condition - stroke / hypothyroidism
- depression 2y to medication - B-blockers / a-blockers / methyldopa / levadopa / corticosteroids
- seasonal affective disorder
how can you differentiate delirium and dementia?
delirium:
- acute onset / 2y / sleep disturbance / rapidly fluctuating / everything goes at once ‘very quickly’
dementia
- chronic onset / prog / usually 1y / NO SLEEP DISTURBANCE / relatively constant state / timings go first
how would you manage delirium?
4 principles:
- identify and treat the precipitated cause (often UTI in elderly)
- environmental and supportive measures
- regular clinical review and FU
- SEDATION IS A LAST RESORT
what medication might you use for sedation in delirium as a last resort…
and who wouldn’t you use certain ones for…
Haloperidol - NOT in PD / parkinsonism / Lewy-body dementia / long QT
Lorazepam if Haloperidol CI
s and s of mania
elevated or expansile or irritable mood
psychomotor activity
speech (pressure) and thought (flight of ideas)
goal directed activity (hypomania / mania)
components of a mental state examination
theres a mnemonic…. - ironic mnemonic…
ASEPTIC
appearance / behaviour speech emotion (mood + affect) perception (hallucinations/ illusions??) thought (content , form) insight cognition (do an AMT / MMSE)
diagnostic criteria for anorexia?
- wt less than 85% of predicted OR BMI <17.5
- intense fear of gaining weight / becoming fat with persistent behaviour interefering with weight gain
- feeling fat when thin.
symptoms of anorexia
signs of anorexia:
general symptoms: fatigue / cognition decreased / altered sleep cycle / cold sensitivity / dizziness
signs: lanugo hair (fine downy hair all over body), dental caries / dry skin / brittle hair / peripheral neuropathy
loads of blood test stuff: read in ox handbook
screening questionairre for anorexia (there’s obviously an acronym)
SCOFF
ever make yourself SICK because you feel too full?
worry you’ve lost CONTROL over eating?
recently lost more than ONE STONE in 3 months?
do you think you’re FAT when others say you’re thin
does FOOD dominate your life?
what is the main condition you worry about in people with anorexia who have been admitted to hospital and are being treated?
what are the main complications of it?
REFEEDING SYNDROME
potentially fatal
low phosphate and low K+ (think the K+ gets drawn up into the cells when blood glucose increases (and it’s already low…)
due to rapid initiation of food after>10days malnutrition
resp / cardiac failure
arrythmias
seizures
sudden death
treatment:
dietician - slow refeeding, careful calorie increase
monitor the serum PO3-
and gluocse (may go up) K+ (hypo) and Mg2+ (may increase)
Tx: thiamine, vitamin B complex (?pabrinex) and multivit
increase dietary intake over 4-7days…
