Psychiatric complications of physical disorders Flashcards
What are some presentations of confusion?
Disorientation – to time, place or person
Misinterpretation – of events and information
Misidentification – of people and places
Auditory or visual hallucinations – depending on the underlying cause of confusion
What are the 2 broad categories of confusion causes?
Transient
Enduring
What are some transient causes of confusion?
Delirium
Post-ictal confusion
Migraine
Delirium tremens
Physical ill-health and chronic illness.
Intoxication – covered in substance misuse session
Medications
What are some enduring causes of confusion?
Acquired brain injury
Dementia
Alcohol related dementia
What is delirium?
An acute confusional state associated with physical insult, injury or environmental factors
When does delirium usually occur?
Within 1-2 days of the precipitating insult
What are some presentations of delirium?
- Disorientation; time, place, person
- Fluctuating confusion, diurnal variation evening and night often worse than day time
- Agitation and distress
- Inattention
- Auditory or visual hallucinations – often vivid.
- Patients may be aggressive as a result of fear and confusion
What are the 3 types of delirium?
Hypoactive
Hyperactive
Mixed
What is meant by hypoactive delirium?
quiet, confused, drowsy, fearful patient
What is meant by hyperactive delirium?
Driven, wandering , agitated, shouting out and often aggressive
What is the prognosis of delirium?
35-40% of patients who experience a period of delirium die within one year of the episode. Significant barriers to appropriate medical treatment (e.g. may be too agitated for IV lines), rehabilitation and recovery.
How is delirium managed?
- Treat underlying cause
- Reassurance and reorientation
- Low stimulus environment
- Assistance with activities of daily living during recovery
- Assistance with medications
- Use of appropriate legal measures (adults with incapacity, mental capacity act, vulnerable adult measures) to allow for treatment
- Medication to help with distress
What is post-ictal confusion?
An abnormal condition following a seizure, characterised by drowsiness, nausea, confusion and exhaustion
How long does post-ictal confusion usually last
Around 30 minutes after the seizure but can last for hours or days
What are some psychiatric complications of migraine?
- Confusion
- Visual changes
- Irritability
- Low mood
- De-realisation “nothing is real”
- De-personalization “I am not real”
- De’ja vu
What are some symptoms of delirium tremens?
Auditory hallucinations
Visual hallucinations - often of insects of tiny things (e.g. ants, spiders, tiny people)
Tactile hallucinations – things crawling on the skin
Confusion
Disorientation
Sweating
High blood pressure
What are some chronic illnesses that can cause confusion?
Encephalitis
Hypoglycaemia
Hypothyroidism/Hyperthyroidism
Vit B12 deficiency
Anaemia
Electrolyte disturbances
What are some medications that can cause confusion?
Analgesics – particularly opioid medications and gabapentinoids
Steroids
Benzodiazepines
Narcotics – zopiclone, zolpidem
NSAIDS
H2 receptor antagonists – digoxin, beta-blockers
What are some causes of acquired brain injury?
Trauma
Hypoxia.
Stroke
Aneurysm
Intracranial tumours
Surgical intervention
What are some symptoms of acquired brain injury?
dizziness, vomiting, exhaustion, headaches, sleep disturbance and seizure.
What are some long-term psychiatric complications of acquired brain injury?
Cognitive disturbance
Motor disturbance
Emotional dysregulation
Impulsivity
Enduring personality change
What is alcohol related dementia?
Neuronal damage secondary to long-term alcohol use
Severe end of a spectrum of disorders collectively named Alcohol related Brain Injuries (ARBI)
What is the prognosis of alcohol related brain injury?
If a patient with ARBI remains abstinent from alcohol from 9-12 months then some degree of the damage may be reversed.
What is confabulation?
The brain filling gaps in memory with tales from the memory bank
