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Psychiatry > Psychiatric Complications of Physical Disorders > Flashcards

Psychiatric Complications of Physical Disorders Flashcards

1
Q

What is the most common mental health problem in hospitalised patients over 65?

A

Delirium

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2
Q

Describe delirium

A

Impaired consciousness with intrusive abnormalities of perception and affect

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3
Q

What kind of impact does under treatment for delirium have?

A

Adverse impact on length of stay, morbidity and mortality

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4
Q

What % of bases of delirium are missed?

A

30-60%

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5
Q

State the 3 main features of delirium.

A
  • Rapid onset
  • Transient and fluctuating course
  • Lasts days to months depending on the underlying cause
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6
Q

What can cause delirium?

A

Basically anything that can make you unwell

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7
Q

List 5 things that should be considered during the diagnosis of someone with delirium.

A
  • Impaired consciousness
  • Disturbance of cognition
  • Psychomotor disturbance
  • Disturbance of sleep-wake cycle
  • Emotional disturbance
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8
Q

If there is no cause found for the delirium then it cannot be delirium

A

FALSE - even if no cause is found, it is still delirium

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9
Q

Outline risk factors for delirium.

A

Frailty
Dementia
Previous episode
Perioperative – long surgery/emergency surgery
Extremes of sensory e.g hypothermia/hyperthermia
Existing sensory deficits – deafness/blindness
Immobility
Social isolation
New environnent
Stress

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10
Q

What investigation should always be done in a patient with delirium?

A

Cognitive test - MMSE, CAM

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11
Q

What other investigations should be done and why?

A 
Urine analysis
FBC, U+E’s, LFT’s
Thyroid
Blood glucose
C-reactive protein
B12 + folate
CXR
MRI/CT brain
EEG – low wave activity
  • We want to try and work out the cause of the delirium
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12
Q

What should you always ask?

A

When did it all start?
Were you ok last week?

If yes - probably delirium

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13
Q

What are the 4 areas of management?

A
  1. Identify and treat cause
  2. Manage environment and provide support
  3. Prescribe
  4. Review
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14
Q

What class of drug should be avoided in delirium? Why?

A

Sedative drugs - they can worsen delirium

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15
Q

List some different strategies that can be used in environmental management.

A 
Quiet side room
Well lit
Remove unnecessary equipment
Constant orientation
Encourage minimal staff changes
Meet basic needs
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16
Q

According to NHS Tayside Policy, what is the first line treatment for delirium?

A

HALLOPERIODOL - 0.5-5mg oral then IM

17
Q

According to NHS Tayside Policy, what is the second line treatment for delirium, in patients with

  • Lewy Body Dementia
  • Parkinson’s
  • Neuroleptic Sensitivity
A

Lorazepam

18
Q

In alcohol/sedative withdrawal remember regular prescribing of _______________ after

A

Benzodiazepines

19
Q

What is the mean duration of delirium?

A

1-4 weeks

20
Q

Describe hypoactive delirium.

A 
Quiet, withdrawn, sleepy
Fluctuates through the day
Doesn’t eat or drink
‘Unmotivated’, ‘lazy’, ‘uncooperative’
Not engaging in rehabilitation
‘depressed’ 
Often misdiagnosed as depression
21
Q

Describe mixed delirium.

A

Most common
Often labelled as ‘behavioural’
Asleep all day and awake all night with disruptive behaviours

22
Q

What is the most common neuropsychiatric complication of a stroke?

A

Depression

23
Q

How many patients present with depression after a major stroke?

A

1/3

24
Q

65% of people post-MI will have __________ symptoms

A

DEPRESSIVE

25
Q

What is limbic encephalitis?

A

Encephalitis caused by auto-immunity

26
Q

What channel does the auto-antibodies in limbic encephalitis act against?

A

K channels

27
Q

What are the 3 main symptoms in limbic encephalitis?

A

Sub-acute memory loss
Panic attacks
Partial seizures

28
Q

Who gets limbic encephalitis?

A

Middle aged people

29
Q

What will a brain MRI of someone with limbic encephalitis show?

A

Hyper-intensity medial temporal structures +/- cortical ribboning

30
Q

People with limbic encephalitis are often hypernatraemic

A

FALSE - hyponatraemic

31
Q

What cancer is NMDA Receptor Antibody Encephalitis associated with?

A

Teratoma

32
Q

Who gets NMDA Receptor Antibody Encephalitis?

A

Young women - median age is 22

Psychiatry (31 decks)

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