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PSYCHIATRY > Psychiatric Complications of Physical Disorders > Flashcards

Psychiatric Complications of Physical Disorders Flashcards

1
Q

What happens in delirium?

A

Patients have impaired consciousness which causes abnormal and intrusive perceptions

=> patients misperceive benign visual stimuli as unpleasant

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2
Q

What features are required for a diagnosis of delirium?

A
  • Impairment of consciousness (drowsy -> coma)
  • Disturbance of Cognition
  • Psychomotor Disturbance
  • Disturbance of sleep-wake cycle
  • Emotional disturbance
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3
Q

What cognitive disturbances are usually present in delirium?

A 
Disorientation in time, place and person
Memory/attention deficits
Impaired perception (hallucinations/illusions/delusions)
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4
Q

What is meant by the psycho-motor disturbances seen in delirium?

A

Hyperactive - agitated, aggressive, hallucinating
Hypoactive - (often missed) withdrawn, sleepy
Mixed

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5
Q

How is a person’s sleep-wake cycle disturbed during delirium?

A

insomnia
reversal of cycle => awake at night, asleep during day
Nocturnal worsening of symptoms
Nightmares

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6
Q

How do patients with delirium become emotionally disturbed?

A
  • Depression/anxiety
  • fear
  • apathy/withdrawn
  • irritated/aggressive
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7
Q

Describe the typical onset and course of a delirium?

A

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

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8
Q

In what groups of patients is delirium most prevalent?

A

Elderly inpatients
Oncology
AIDS
Terminally ill

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9
Q

What can cause a delirium?

A 
Literally ANYTHING
e.g. 
infection
hypoxia
serious bleeds
etc
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10
Q

Why does it take a very serious insult to give younger patients delirium?

A

Reserve capacity of brain is high

=> only usually caused by large trauma, high dose of analgesia etc

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11
Q

Drugs can cause delirium even after they are stopped. TRUE/FALSE?

A 
TRUE
if patient experiences withdrawal this can make them delirious
=> Sedatives (benzodiazepines)
=> Barbiturates
=> Alcohol and Illicit drugs
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12
Q

What types of drugs are known to cause a delirium?

A 
Anticholinergics
Anticonvulsants
Anti-parkinsons drugs
Steroids
Opiates
Sedatives
ALCOHOL
ILLICIT DRUGS
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13
Q

If you cannot identify a cause for delirium then this should be excluded as a diagnosis. TRUE/FALSE?

A

FALSE

sometimes a cause will never be found but patient will still be considered delirious

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14
Q

What are the main risk factors for the development of delirium?

A 
age
dementia
previous episode of delirium
surgery
existing sensory deficits (sight/hearing problems)
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15
Q

What are the main investigations used in delirium?

A

FORMAL Cognitive tests (MMSE, 4AT, ACE-R, MoCA)

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16
Q

What other investigations would you do in patients with delirium to rule out reversible causes?

A

FBC, U&Es
Thyroid Function Tests
B12 and folate

17
Q

How is treatment of delirium usually approached?

A

Identify and treat the cause (if possible)
Manage environment and provide support
Prescribe
Review

18
Q

What is included in the 4AT tool for delirium?

A

Alertness
Orientation
Attention
Acute change/fluctuating

19
Q

If a patient with delirium is requiring to beb sedate dto comply with examination/investigations, what sedative should be used?

A

Short acting e.g. lorazepam

as opposed to diazepam etc

20
Q

How should we modify a delirious patients environment to make them more comfortable?

A
  • Quiet and well lit side room (if possible)
  • Remove unnecessary equipment
  • Educate staff to reassure patients (often scared/frightened by their delirium)
  • Use items to orientate the patient (TV on, newspapers, clock, reminders from home etc)
  • Correct sensory impairment by making sure they have glasses/ hearing aids etc
21
Q

What treatments can be prescribed for delirium?

A

Sedating drugs can worsen delirium by increasing confusion and unsteadiness
=> Antipsychotics are standard treatment e.g. Haloperidol

22
Q

Why is it important to review patients with delirium?

A
  • patients can improve quickly
    => no longer need prescribed meds!
  • patients can worsen quickly and suffer seizures/injuries/sudden death
  • Follow Up – repeat cognitive assessment to avoid misdiagnosis of dementia
23
Q

What patients should NOT be given haloperidol when treating delirium?

A

Parkinson’s
Lewy Body Dementia
Neuroleptic Sensitivity

24
Q

What is the average duration of a delirium?

A
  • Mean duration of Delirium is 1-4 Weeks
  • Often longer in the elderly
  • A minority can become chronic
25
Q

What is the most common neuropsychiatric complication of stroke?

A

Post stroke depression

26
Q

How many patients have a Major Post stroke depressive episode?

A

Up to 1/3 of stroke patients

27
Q

How many patients experience depression following an MI?

A

65% patients = depressive symptoms

15-22% of these = major depression

PSYCHIATRY (35 decks)

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