Psychiatric Complications of Physical Disorders Flashcards
what is delerium
impaired consciousness with intrusive abnormalities of perception and affect
diagnostic criteria for delerium
impairment of consciousness
disturbance of cognition
psychomotor disturbance (
disturbance of sleep-wake cycle
emotional disturbance
what are the symptoms of hyperactive delerium
agitation disorientation hallucination delusion aggression
what is hypoactive delerium
confusion
sedation
depression is often a miss diagnosis
what is mixed delerium
fluctuating symptoms of both types
most common
what types of sleep disturbance is seen in delerium
Insomnia Sleep loss Reversal of sleep cycle Nocturnal worsening of symptoms (sundowning) Disturbing dreams and nightmares
what are some general features of delerium
Rapid onset
Transient and fluctuating course
Lasts days to months depending on underlying cause
what can cause delerium
ANYTHING
most common are:
Drugs Withdrawal Metabolic Infections Head trauma Epilepsy Neoplastic diseases Vascular disorders
delerium requires an identifiable cause to be diagnoses true/false
false
always delerium until proven otherwise - does not need an identifiable cause
what are some risk factors for delerium
Age Cognitive deficit Existing sensory deficits Previous episode Perioperative Extremes in sensory experience Immobility Social isolation New environment Stress
what investigations are done for delerium
History and full examination Cognition tests (4AT) Urine analysis FBC, U&Es, LFTS Thyroid function Blood glucose C-reactive protein B12 and folate CXR MRI/CT brain EEG
how do you manage delerium
manage risk factors
identify and treat cause (sedation may be necessary to allow examination and investigations)
manage environment and provide support (educate all staff, reality orientation (clocks, calendars etc), correct sensory impairment (hearing aids, glasses), put in side room to reduce unnecessary noise/unsafe objects. Ensure basic needs met.
prescribe (Sedation can worsen delerium, alcohol withdrawal needs benzodiazepines, otherwise antipsychotics are standard)
review (can improve quickly or worsen quickly and suffer seizures, injuries and sudden death) - follow up
what is the first line antipsychotic in delerium
haloperidol
or Lorazepam for Parkinson’s, LB dementia, neuroepeleptic sensitivity
One drug at a time - start with low dose and increase
what is the average duration of delerium
1-4 weeks
often can be longer in elderly
minority can become chronic
what is potassium channel antibody-associated encephalopathy
sub-acute memory loss
‘panic attacks’
partial seizures
