Psychiatric complications of physical disease

Question 1

Diagnostic features of delirium (5)

Answer 1

Impairment of consciousness
Disturbance of cognition
Psychomotor disturbance
Disturbed sleep-wake cycle
Emotional disturbance

Question 2

Features of disturbed cognition (4)

Answer 2

Disorientation (usually time)
Impaired memory and attention
Impaired thinking
Perceptual disturbance

Question 3

What does “sundowning” mean?

Answer 3

Worsening of symtpoms at night

Question 4

The prevalence of delirium is particularly high in which groups? (3)

Answer 4

AIDS patients
Terminally ill
Elderly

Question 5

Components of the confusion assessment method

Answer 5

2 of the following:
Acute onset and fluctuating course
AND inattention
AND EITHER disorganised thinking, OR altered level of consciousness

Question 6

How can the environment be optimised in treatment of delirium? (4)

Answer 6

Orientation e.g. clock, calendar
Reduce sensory over-stimulation e.g. peace and quiet
Familiar objects from home e.g. photos
Correct sensory impairments e.g. hearing aids, glasses

Question 7

Why should sedating drugs be given with caution?

Answer 7

Can worsen delirium by causing confusion and unsteadiness

Question 8

Standard first-line treatment (pharmacological) for delirium

Answer 8

Haloperidol 1-10mg (or 0.5mg in elderly)

Question 9

In which groups of patients should haloperidol not be given and why? What drug should be given instead?

Answer 9

Parkinsons, Lewy Body dementia- worsens extrapyramidal symptoms. Give lorazepam

Question 10

What is the most common psychiatric complication of stroke?

Answer 10

Depression