Psychiatric Complications of Physical Disorders- Delirium Flashcards
What is delirium?
Impaired consciousness with intrusive abnormalities of perception and affect
What are the aspects assessed in delirium diagnosis?
Impairment of consciousness Disturbance of Cognition Psychomotor Disturbance Disturbance of sleep-wake cycle Emotional disturbance
How is impairment of consciousness assessed?
On continuum- clouding, drowsiness, sopor, coma (GCS)
How is disturbance of cognition assessed?
Includes:
Disorientation for time, but sometimes place and person also
Impaired memory and attention
Impaired thinking
Perceptual disturbance, hallucinations and illusions (commonly visual)
How is psychomotor disturbance assessed?
Variants:
Hyperalert/active- agitation, disorientation, hallucinations and delusions, sometimes aggressive
Hypoalert/active- confusion, sedation (depression misdiagnosis)
Mixed- fluctuating symptoms of both types
How is sleep-wake cycle disturbance assessed?
Types: Insomnia Sleep loss Reversal of sleep cycle Nocturnal worsening of symptoms- sundowning Disturbing dreams and nightmares
How is emotional disturbance assessed?
Affective disturbances: 'Depression' Anxiety Fear Irritability Euphoria Apathy Perplexity Aggression
What are the general characteristics of the aspects of delirium?
Rapid onset
Transient and fluctuating course
Lasts days to months depending on underlying cause
What are the CVS causes of delirium?
Intracranial/subdural bleed
MI
PE
Cardiac failure
What are the respiratory causes of delirium?
Hypoxia
What are the GI causes of delirium?
Liver failure
Pancreatitis
What are the endocrine causes of delirium?
Complications of DM
Thyroid disorders
What are the GU causes of delirium?
UTI
Renal failure
What are the toxic causes of delirium?
Alcohol
Drugs (prescribed and illicit)
What are the neurological causes of delirium?
Head Injury Meningitis Encephalitis Tumours Epilepsy
What are the more general causes of delirium?
Trauma- accidental or surgical Infectious Drugs Withdrawal Metabolic Head Trauma Epilepsy Neoplastic diseases Vascular disorders
What drugs can cause delirium?
Anticholinergic agents Anticonvulsants Anti-parkinsonian drugs Steroids Cimetidine Opiates Sedatives Alcohol Illicit drugs
Withdrawal effects from what can cause delirium?
Alcohol
Sedatives (benzos)
Barbiturates
Illicit drugs
What are the metabolic causes of delirium?
Hypoxia Hypoglycaemia Compromised liver/kidney function Deranged fluid/electrolyte balance Hypo/hyperthyroidism Hypopituitarism Hypo/hyperparathyroidism Porphyria Carcinoid syndrome
What aspects of epileptic seizures are related to delirium?
Aura
Ictal
Interictal
Postictal
What vascular disorders can cause delirium?
Transient ischaemic attacks Thrombosis Embolism Migraine Myocardial Infarction Cardiac Failure
What are the RFs for delirium?
Age- elderly patients Cognitive deficit- Dementia Existing sensory deficits- Deafness/blindness Previous episode Perioperative- Long/emergency surgery Extremes in sensory experience -Hypo/hyperthermia Immobility Social isolation New environment Stress
What Ix should be carried out in delirium?
History and full physical examination FORMAL Cognitive tests (MMSE, CAM, ACE-R, MoCA) Urine analysis FBC, U&Es, LFTS Thyroid function Blood glucose C-Reactive Protein B12 and folate CXR MRI / CT Brain Consider EEG Be guided by emerging underlying cause
What may be seen on EEG in delirium investigation?
Diffuse background slow-wave activity
