Psychiatric Complications of Physical Disease Flashcards
5 features of delirium?
impaired consciousness (alertness/awakeness)
disturbance of cognition (disorientation of time/place, hallucinations etc)
psychomotor disturbance (hyperactive/hypoactive/mixed)
disturbance of sleep-wake cycle (insomnia, sundowning, disturbing dreams and nightmares)
emotional disturbance
general features?
rapid onset
transient and fluctuating course
lasts days to months
common causes of delirium?
drugs infection CVD resp disorders (hypoxia) GI disorders (liver failure, pancreatitis) endocrine disorders (hypoglycaemia, electrolyte balance, thyroid etc) GU intoxication neurological trauma
withdrawal from what can cause delirium?
alcohol
sedatives (eg benzodiazepines)
barbiturates
illicit drugs
what drugs can cause delirium?
anticholinergics anticonvulsants anti-parkinsonian steroids cimetidine opiates sedatives alcohol illicit drugs
examples of neurological disorder which can cause delirium?
epilepsy
risk factors for delirium?
age cognitive defect (e.g dementia) sensory deficit previous episode perioperative extremes in sensory experience (hypo/hyperthermia) immobility social isolation new environment stress
important investigations in delirium?
formal cognitive tests (4AT) urine analysis FBC, Us&Es, LFTs thyroid function glucose CRP B12 and folate CXR MRI/CT brain consider EEG
how is delirium managed?
identify and treat cause
manage environment and give support
prescribe
review
what medication may be used in delirium?
benzodiazepines in alcohol withdrawal (chlordiazepoxide or diazepam)
may need sedation if very severe (lorazepam) but try to avoid as can worsen delirium by increasing confusion
antipsychotics are standard treatment (haloperidol 1-10mg/0.5mg in elderly)
NHS Tayside protocol for delirium?
haloperidol 0.5-5mg orally then IM up to 10mg in 24 hrs
lorazepam 0.5-2mg up to 2X in 24 hrs (for lewy body dementia, parkinsons and neuroleptic snesitivity)
regular prescribing of antipsychotic (haloperidol) in other causes of delirium may be needed
regular prescribing of benzodiazepines in alcohol/sedative withdrawal
prognosis of delirium?
usually lasts 1-4 weeks
but can be longer than this in elderly
risk factor for developing cognitive impairment
most common delirium?
mixed
major depression is common after which 2 acute conditions?
MI
stroke
potassium channel antibody associated encephalopathy?
subacute memory loss, panic attacks and partial seizures
