Psychiatric Complications of Physical Disorders Flashcards
What is the commonest mental health problem in hospitalised elderly patients?
Delirium
Give some of the main signs of delirium
Impairment of consciousness Cognition disturbance Psychomotor disturbance Sleep-wake cycle disturbance Emotional disturbance
How may a delirious patient with impaired consciousness present?
Clouding
Drowsiness
Comatose
Give some examples of disturbed cognition seen in delirium
Disorientation
Impaired memory/attention
Impaired thinking
Hallucinations
What type of hallucinations are most commonly seen in delirium?
Visual
How may psychomotor disturbance in delirium present?
Hyperactive
Hypoactive
Mixed
Patients with delirium commonly have their symptoms worsen at day/night
Night - sundowning
What types of sleep disturbance are seen in delirium?
Insomnia
Sleep loss
Reversal of sleep cycle
Nightmares
Give some examples of affective disturbance seen in delirium
Fear
Anxiety
Irritability
Euphoria
What are the general features of delirium?
Rapid onset
Transient and fluctuating course
Lasts days-to-months
Which age group of patients have the highest percentage of delirium?
80+
List some general causes of delirium (everything not acceptable)
CV disorders Respiratory disorders GI disorders Endocrine disorders GU disorders Intoxication Neurological disorders Trauma
What drugs have a high risk of causing delirium?
Anticholinergics Anticonvulsants Anti-Parkinsons Steroids Opiates Alcohol
Give some metabolic causes of delirium
Hypoxia
Hypoglycaemia
Hypo/hyperthyroidism
Hypopituitarism
If no cause of delirium is identified then delirium cannot be the diagnosis. True/false?
False - not finding cause does not exclude diagnosis
Give some general risk factors for delirium
Age Dementia Deafness/blindness Perioperative Immobility Stress
What is the main cognitive test used to diagnose delirium?
4AT
What is assessed within the 4AT?
Alertness
AMT4
Attention
Acute change/fluctuating course
What is the most important step is managing delirium?
Identifying and treating the cause
What can be done to manage the environment and help treat delirium?
Well lit quiet side room
Constant orientation
Minimal staff changes
What drug is given as standard to manage delirium?
Haloperidol
When is lorazepam used to manage delirium?
Parkinson’s
Lewy body dementia
Alcohol withdrawal
Up to how many patients have post-stroke depression?
1/3
What % of patients have depressive symptoms following an MI?
65%
