Psychiatric Complications of Physical Disorders

Question 1

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

Answer 1

DELIRIUM

Question 2

Diagnosing delirium

Answer 2

Impairment of consciousness

• clouding
• drowsiness
• Sopor
• Coma

Disturbance of cognition
- Disorientation for time, but
sometimes place and person also
- Impaired memory and attention  
- Impaired thinking
- Perceptual disturbance,  hallucinations and illusions  (commonly visual)

Psychomotor disturbance

Disturbance of sleep wake cycle

Emotional disturbance

Question 3

General features of delirium

Answer 3

Rapid onset
Transient and fluctuating
Lasts days to months depending on underlying cause

Question 4

Describe disturbance of sleep wake cycle during delirium

Answer 4

Insomnia Sleep loss
Reversal of sleep cycle Nocturnal worsening of
symptoms - sundowning

Disturbing dreams and nightmares

Question 5

Describe psychomotor variants in delirium

Answer 5

Hyperalert/Hyperactive - agitation, disorientation, hallucinations and delusions, sometimes aggressive

Hypoalert/Hypoactive -
confusion, sedation- depression misdiagnosis

Mixed-fluctuating symptoms of both

Question 6

Risk factors for delirium

Answer 6

Age
- elderly patients

Cognitive deficit DEMENTIA

Existing sensory deficits
-Deafness/blindness

Previous episode

Perioperative

• Long surgery
• Emergency surgery

Extremes in sensory experience
- Hypo/hyperthermia
Immobility

Social isolation

New environment

Stress

Question 7

Describe emotional disturbances seen in delirium

Answer 7

“Depression”
Anxiety
Fear  
Irritability 
Euphoria  
Apathy  
Perplexity  
Aggression

Question 8

List causes of delirium (8)

Answer 8

1. Drugs
2. Withdrawal - alcohol, illicit drugs, sedatives (benzo), barbiturates
3. Metabolic
4. Infections
5. Head Trauma
6. Epilepsy
7. Neoplastic diseases
8. Vascular disorder

Question 9

What are the drugs that cause delirium?

Answer 9

Anticholinergic agents  Anticonvulsants
Anti-parkinsonian drugs  Steroids
Cimetidine 
Opiates
Sedatives
ALCOHOL  
ILLICIT DRUGS

Question 10

What are the metabolic causes of delirium?

Answer 10

Hypoxia  
Hypoglycaemia
Compromised liver/kidney  function
Deranged fluid/electrolyte  balance
Hypo/hyperthyroidism
Hypopituitarism
Hypo/hyperparathyroidism  Porphyria
Carcinoid syndrome

Question 11

What are the epileptic causes of delirium?

Answer 11

“Aura”
Ictal
Interictal
Postictal

Question 12

Which vascular disorders cause delirium?

Answer 12

Transient ischaemic  attacks
Thrombosis  
Embolism  
Migraine
Myocardial Infarction  
Cardiac Failure