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Psychiatry > Psychiatric Complications of Physical Disorders- Delirium > Flashcards

Psychiatric Complications of Physical Disorders- Delirium Flashcards

1
Q

What is delirium?

A

Impaired consciousness with intrusive abnormalities of perception and affect

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2
Q

What are the aspects assessed in delirium diagnosis?

A 
Impairment of consciousness
Disturbance of Cognition
Psychomotor Disturbance
Disturbance of sleep-wake cycle
Emotional disturbance
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3
Q

How is impairment of consciousness assessed?

A

On continuum- clouding, drowsiness, sopor, coma (GCS)

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4
Q

How is disturbance of cognition assessed?

A

Includes:
Disorientation for time, but sometimes place and person also
Impaired memory and attention
Impaired thinking
Perceptual disturbance, hallucinations and illusions (commonly visual)

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5
Q

How is psychomotor disturbance assessed?

A

Variants:
Hyperalert/active- agitation, disorientation, hallucinations and delusions, sometimes aggressive
Hypoalert/active- confusion, sedation (depression misdiagnosis)
Mixed- fluctuating symptoms of both types

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6
Q

How is sleep-wake cycle disturbance assessed?

A 
Types:
Insomnia
Sleep loss
Reversal of sleep cycle
Nocturnal worsening of symptoms- sundowning
Disturbing dreams and nightmares
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7
Q

How is emotional disturbance assessed?

A 
Affective disturbances:
'Depression'
Anxiety
Fear
Irritability
Euphoria
Apathy
Perplexity
Aggression
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8
Q

What are the general characteristics of the aspects of delirium?

A

Rapid onset
Transient and fluctuating course
Lasts days to months depending on underlying cause

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9
Q

What are the CVS causes of delirium?

A

Intracranial/subdural bleed
MI
PE
Cardiac failure

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10
Q

What are the respiratory causes of delirium?

A

Hypoxia

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11
Q

What are the GI causes of delirium?

A

Liver failure

Pancreatitis

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12
Q

What are the endocrine causes of delirium?

A

Complications of DM

Thyroid disorders

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13
Q

What are the GU causes of delirium?

A

UTI

Renal failure

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14
Q

What are the toxic causes of delirium?

A

Alcohol

Drugs (prescribed and illicit)

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15
Q

What are the neurological causes of delirium?

A 
Head Injury
Meningitis
Encephalitis
Tumours
Epilepsy
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16
Q

What are the more general causes of delirium?

A 
Trauma- accidental or surgical
Infectious
Drugs
Withdrawal
Metabolic
Head Trauma
Epilepsy
Neoplastic diseases
Vascular disorders
17
Q

What drugs can cause delirium?

A 
Anticholinergic agents
Anticonvulsants
Anti-parkinsonian drugs
Steroids
Cimetidine
Opiates
Sedatives
Alcohol
Illicit drugs
18
Q

Withdrawal effects from what can cause delirium?

A

Alcohol
Sedatives (benzos)
Barbiturates
Illicit drugs

19
Q

What are the metabolic causes of delirium?

A 
Hypoxia
Hypoglycaemia
Compromised liver/kidney function
Deranged fluid/electrolyte balance
Hypo/hyperthyroidism
Hypopituitarism
Hypo/hyperparathyroidism
Porphyria
Carcinoid syndrome
20
Q

What aspects of epileptic seizures are related to delirium?

A

Aura
Ictal
Interictal
Postictal

21
Q

What vascular disorders can cause delirium?

A 
Transient ischaemic attacks
Thrombosis
Embolism
Migraine
Myocardial Infarction
Cardiac Failure
22
Q

What are the RFs for delirium?

A 
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
23
Q

What Ix should be carried out in delirium?

A 
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
24
Q

What may be seen on EEG in delirium investigation?

A

Diffuse background slow-wave activity

25
Q

How do you manage delirium?

A

Identify and treat cause
Manage environment and provide support
Prescribe
Review

26
Q

How do you manage the environment and provide support in delirium?

A

Educate: make all staff aware
Reality orientation: clear communication, clock, calendar
Correct sensory impairments:i.e. bring in glasses / hearing aids from home
Bright sideroom, unnecessary noise reduced, “unsafe” objects removed
Ensure basic needs met (food, water, warmth)

27
Q

What should be prescribed in delirium?

A

Antipsychotics as standard- Haloperidol 1-10mg (0.5 in elderly) orally then IM, up to 10mg in 24 hours
Lorazepam 0.5-2mg, up to 2x in 24hours- For PD, LBD, Neuroleptic sensitivity

28
Q

What should not be prescribed in delirium?

A

Sedating drugs

Can worsen delirium by increasing confusion and unsteadiness, practical management first

29
Q

What does alcohol/sedative withdrawal as a cause of delirium require for treatment

A

Reducing scale of benzos: commonly chlordiazepoxide or diazepam
Regular prescribing still required

30
Q

What is the mean duration of delirium?

A

1-4wks

31
Q

What is the most common neuropsychiatric complication of stroke?

A

Post Stroke Depression

32
Q

What psychiatric complication do 65% of MI patients go on to have?

A

Depression

Psychiatry (29 decks)

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