Psychiatric Complications of Physical Disorders Flashcards
Delirium is commonly seen in what age group?
Over 65 y.o
What are the fts of Delirium?
- Impaired Consciousness
- Disturbed cognition
- psychomotor disturbance
- disturbance of SLEEP-WAKE cycle
- emotional disturbance
What is the range of impaired consciousness?
Clouding>Drowsiness> Sopor (deep sleep)> COMA
How to recognise if the pt has disturbance of Cognition?
- disorientation of TIME (severe- Person)
- Impaired attention and Memory
- impaired thinking
- perceptual disturbance : Hallucinations and Illusions
What psychomotor disturbance is seen in a Hyperactive delirious person?
- AGITATION
- hallucinations and delusions
- sometimes aggressive
- disorientated
WHat psychomotor changes are seen in a hypoactive delirious person?
- confusion
- sedation
- MISDIAGNOSIS of depression
What are the diff. types of sleep disturbance?
- insomnia
- sleep loss
- reversal of sleep cycle (SLEEPS at night)
- nocturnal worsening of symptoms
- nightmares
What emotional disturbance may they be going through?
- fear, anxiety
- irritability
- EUPHORIC
- apathetic
- Perplexity
- aggression
How long do these general features last?
- days to months (until underlying cause is treated)
- transient course and RAPID onset
Apart from elderly patients, who is affected with delirium?
- cancer pts
- AIDS pts
- Terminally ill pts
- in-patients
What neurological disorders lead to delirium?
- Head INJURY
- Meningitis
- Tumors
- Epilepsy
- Encephalitis
What Genitourinary d.os cause delirium?
- UTI
- Renal failure
What endocrine d.os cause delirium?
-complications of DIABETES and THYROID disorder
What CVS d.o may cause delirium?
- PE
- MI
- CHF
- intracranial/subdural bleed
Which GI problem leads to delirium?
pancreatitis
Liver failure
Other causes of delirium?
- infections
- drugs and alcohol
- trauma
- hypoxia
What drugs are said to cause delirium?
- illicit drugs
- alcohol
- anti-convulsants
- anti-parkinsonian drugs
- steroids
- opiates
- sedatives
- anticholinergics
Withdrawal from a few substances may also trigger delirium…name 4.
- sedative (Benzodiazepines)
- Barbiturates
- Illicit drugs
- alcohol
What metabolic causes result in delirium?
- hypoxia
- hypoglycemia
- compromised LIVER/ KIDNEY fxn
- HYPO-/HYPERthyroidism
- hypopituitarism
- hypo-/hyperparathyroidism
- porphyria
- carcinoid syndrome
Name vascular disorders, from which Delirium may arise from.
- TIAs
- Thrombosis
- Embolism
- Migraine
- MI
- CHF
What external factors put an individual at risk of becoming delirious?
- Social ISOLATION
- NEW environment
- STRESS
- immobility
- perioperative (LONG surgery, emergency surgery)
What individual factors put a person at risk of delirium?
- AGE
- Cognitive deficit DEMENTIA
- sensory deficits (deafness and blindness)
- extreme sensory experience (HYPO-/HYPERTHERMIA)
What IVX can be done?
- FORMAL cognitive tests (MMSE, CAM)
- Urine analysis
- FBC, U&Es, LFTs
- THYROID fxn
-blood glucose - C-REACTIVE protein
-B12 and FOLATE - CXR. MRI, CT brain
EEG
When is sedation administered in a delirious pt?
- to allow examination
- ivx
How should the env. of a delirious pt be managed? (5)
- make ALL staff aware (minimal staff change)
- REALITY orientation (place clock and calendar in room)
- correct sensory impairments (bring in reading glasses, hearing aids from home)
- put pt in BRIGHT sideroom, with minimal noise, remove UNSAFE objects
- ensure basic needs are met (food, water and warmth)
What to prescribe regularly to a delirious patient?
- Anti-psychotics is STANDARD (haloperidol 1-10mg)
What is the NHS Tayside protocol for delirious management?
- Haloperidol (0.5-5mg); orally then IM (upto 10mg in 24hrs)
- Lorazepam (0.5-2mg) —up to 2x in 24HRS
What is given to an alcohol withdrawal pt?
- benzodiazepam
What is the prognosis like for delirium?
- mean duration: 1-4 weeks
- longer in elderly (may become CHRONIC)
- RISK OF PERSISTENT cognitive impairment and DEPRESSIOn
What s the most COMMON neuropsychiatric complication post stroke?
- Post STROKE DEPRESSION
- treatable, not preventable
- —affects COGNITION, MOTIVATION and REHABILITATION
How does post MI depression affect the pt’s wellbeing?
- 22% have MAJOR depression
- increases MORTALITY
- risk factor for development of CV disease
