Psychiatric Complications of Physical Disorders Flashcards
What is the most common mental health problem in hospitalised patients over 65?
Delirium
Describe delirium
Impaired consciousness with intrusive abnormalities of perception and affect
What kind of impact does under treatment for delirium have?
Adverse impact on length of stay, morbidity and mortality
What % of bases of delirium are missed?
30-60%
State the 3 main features of delirium.
- Rapid onset
- Transient and fluctuating course
- Lasts days to months depending on the underlying cause
What can cause delirium?
Basically anything that can make you unwell
List 5 things that should be considered during the diagnosis of someone with delirium.
- Impaired consciousness
- Disturbance of cognition
- Psychomotor disturbance
- Disturbance of sleep-wake cycle
- Emotional disturbance
If there is no cause found for the delirium then it cannot be delirium
FALSE - even if no cause is found, it is still delirium
Outline risk factors for delirium.
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
What investigation should always be done in a patient with delirium?
Cognitive test - MMSE, CAM
What other investigations should be done and why?
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
What should you always ask?
When did it all start?
Were you ok last week?
If yes - probably delirium
What are the 4 areas of management?
- Identify and treat cause
- Manage environment and provide support
- Prescribe
- Review
What class of drug should be avoided in delirium? Why?
Sedative drugs - they can worsen delirium
List some different strategies that can be used in environmental management.
Quiet side room Well lit Remove unnecessary equipment Constant orientation Encourage minimal staff changes Meet basic needs
According to NHS Tayside Policy, what is the first line treatment for delirium?
HALLOPERIODOL - 0.5-5mg oral then IM
According to NHS Tayside Policy, what is the second line treatment for delirium, in patients with
- Lewy Body Dementia
- Parkinson’s
- Neuroleptic Sensitivity
Lorazepam
In alcohol/sedative withdrawal remember regular prescribing of _______________ after
Benzodiazepines
What is the mean duration of delirium?
1-4 weeks
Describe hypoactive delirium.
Quiet, withdrawn, sleepy Fluctuates through the day Doesn’t eat or drink ‘Unmotivated’, ‘lazy’, ‘uncooperative’ Not engaging in rehabilitation ‘depressed’ Often misdiagnosed as depression
Describe mixed delirium.
Most common
Often labelled as ‘behavioural’
Asleep all day and awake all night with disruptive behaviours
What is the most common neuropsychiatric complication of a stroke?
Depression
How many patients present with depression after a major stroke?
1/3
65% of people post-MI will have __________ symptoms
DEPRESSIVE
What is limbic encephalitis?
Encephalitis caused by auto-immunity
What channel does the auto-antibodies in limbic encephalitis act against?
K channels
What are the 3 main symptoms in limbic encephalitis?
Sub-acute memory loss
Panic attacks
Partial seizures
Who gets limbic encephalitis?
Middle aged people
What will a brain MRI of someone with limbic encephalitis show?
Hyper-intensity medial temporal structures +/- cortical ribboning
People with limbic encephalitis are often hypernatraemic
FALSE - hyponatraemic
What cancer is NMDA Receptor Antibody Encephalitis associated with?
Teratoma
Who gets NMDA Receptor Antibody Encephalitis?
Young women - median age is 22
