Psychiatric complications of physical disorders

Question 1

What are some presentations of confusion?

Answer 1

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

Question 2

What are the 2 broad categories of confusion causes?

Answer 2

Transient
Enduring

Question 3

What are some transient causes of confusion?

Answer 3

Delirium
Post-ictal confusion
Migraine
Delirium tremens
Physical ill-health and chronic illness.
Intoxication – covered in substance misuse session
Medications

Question 4

What are some enduring causes of confusion?

Answer 4

Acquired brain injury

Dementia

Alcohol related dementia

Question 5

What is delirium?

Answer 5

An acute confusional state associated with physical insult, injury or environmental factors

Question 6

When does delirium usually occur?

Answer 6

Within 1-2 days of the precipitating insult

Question 7

What are some presentations of delirium?

Answer 7

• 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

Question 8

What are the 3 types of delirium?

Answer 8

Hypoactive
Hyperactive
Mixed

Question 9

What is meant by hypoactive delirium?

Answer 9

quiet, confused, drowsy, fearful patient

Question 10

What is meant by hyperactive delirium?

Answer 10

Driven, wandering , agitated, shouting out and often aggressive

Question 11

What is the prognosis of delirium?

Answer 11

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.

Question 12

How is delirium managed?

Answer 12

• 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

Question 13

What is post-ictal confusion?

Answer 13

An abnormal condition following a seizure, characterised by drowsiness, nausea, confusion and exhaustion

Question 14

How long does post-ictal confusion usually last

Answer 14

Around 30 minutes after the seizure but can last for hours or days

Question 15

What are some psychiatric complications of migraine?

Answer 15

• Confusion
• Visual changes
• Irritability
• Low mood
• De-realisation “nothing is real”
• De-personalization “I am not real”
• De’ja vu

Question 16

What are some symptoms of delirium tremens?

Answer 16

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

Question 17

What are some chronic illnesses that can cause confusion?

Answer 17

Encephalitis

Hypoglycaemia

Hypothyroidism/Hyperthyroidism

Vit B12 deficiency

Anaemia

Electrolyte disturbances

Question 18

What are some medications that can cause confusion?

Answer 18

Analgesics – particularly opioid medications and gabapentinoids

Steroids

Benzodiazepines

Narcotics – zopiclone, zolpidem

NSAIDS

H2 receptor antagonists – digoxin, beta-blockers

Question 19

What are some causes of acquired brain injury?

Answer 19

Trauma
Hypoxia.
Stroke
Aneurysm
Intracranial tumours
Surgical intervention

Question 20

What are some symptoms of acquired brain injury?

Answer 20

dizziness, vomiting, exhaustion, headaches, sleep disturbance and seizure.

Question 21

What are some long-term psychiatric complications of acquired brain injury?

Answer 21

Cognitive disturbance
Motor disturbance
Emotional dysregulation
Impulsivity
Enduring personality change

Question 22

What is alcohol related dementia?

Answer 22

Neuronal damage secondary to long-term alcohol use
Severe end of a spectrum of disorders collectively named Alcohol related Brain Injuries (ARBI)

Question 23

What is the prognosis of alcohol related brain injury?

Answer 23

If a patient with ARBI remains abstinent from alcohol from 9-12 months then some degree of the damage may be reversed.

Question 24

What is confabulation?

Answer 24

The brain filling gaps in memory with tales from the memory bank