1: Psychiatric complications of physical disorders (mainly delirium) Flashcards Preview

Psychiatry Week 4 2018/19 > 1: Psychiatric complications of physical disorders (mainly delirium) > Flashcards

Flashcards in 1: Psychiatric complications of physical disorders (mainly delirium) Deck (37)
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1

What are the CAM criteria for delirium?

1. Inattention

2. Disordered thinking AND/OR Change in conscious level

3. Acute onset and fluctuating course

2

What sorts of cognitive disturbances may delirious patients experience?

Impaired memory and attention

Thought disorder

Perceptual changes (hallucinations)

Disorientation (time, space, person)

3

What are the two terms used to describe a patient's psychomotor state?

Hyperactive (agitation)

Hypoactive (retardation)

OR it could be a mixed picture

4

What is psychomotor retardation often misdiagnosed as?

Depression

5

What sort of hallucinations are seen in organic problems?

Visual hallucinations

6

What sort of hallucinations are seen in primary psychiatric illness?

Auditory hallucinations

7

What is "sundowning" in the context of delirium?

Tendency for symptoms to worsen at night

So patients spend the day asleep and are awake (and often agitated) at night

8

Which mood disorder is often misdiagnosed in delirious patients?

Depression

due to psychomotor retardation, sedation, apathy

9

Do you need to have an identified cause of delirium to be officially diagnosed?

No

Underlying cause may have gradual onset or be in subclinical phase

Delirium is a clinical diagnosis

10

What is the usual

a) onset

b) course

c) duration

of delirium?

a) Acute onset

b) Fluctuating course

c) Weeks to months

11

What are the causes of delirium?

Virtually any disease

12

Which group of patients is more susceptible to delirium?

Frail patients with co-morbidities

which tends to be the elderly

13

Apart from diseases, what can cause delirium?

Drugs

14

Which therapeutic drugs can precipitate delirium?

Anticholinergics

Anticonvulsants

Drugs used for PD - levodopa, dopamine agonists

Steroids

15

Which recreational drugs can precipitate delirium?

Alcohol

Illicit drugs

16

Use of drugs can cause delirium.

What else can precipitate it?

Withdrawal from drugs

alcohol, opiates, benzos

17

Any significant ___ to the body can precipiate delirium.

insult

18

How is delirium diagnosed?

Clinically

based off CAM criteria

19

What age of patient is predisposed to developing delirium?

Why?

Elderly

Frail, more likely to have existing comorbidities

20

past psychiatric history of which illnesses predisposes a patient to delirium?

Delirium

Dementia

21

Sensory ___ (e.g hyper/hypothermia) and ___ (e.g deafness, blindness) can precipitate delirium.

Sensory extremes and deficits

22

After which intervention are patients particularly vulnerable to delirium?

Surgery

Perioperative period where patient is recovering

23

Exposing a frail elderly patient to a new ___ may precipitate delirium.

new environment

24

Apart from history and examination, how would you assess a patient's cognitive function?

Formal cognitive testing

so 4AT, MOCA, ACE-III

25

How can the environment of a patient with delirium be improved to prevent unneccessary distress?

Well lit, quiet

Orienting factors (e.g a clock, 24H news)

Minimise staff changes

Remove unneccessary equipment

26

Which renal investigation should be done in patients with delirium?

Urinalysis

to exclude UTI

27

Which blood tests should you request for a delirious patient?

FBC, WCC and inflammatory markers

LFTs and TFTs

Blood glucose

Vit B12 and folate

28

Why must you do a urinalysis for a delirious elderly patient?

UTI is a common cause of delirium in the elderly

29

What is the standard pharmacological management for delirium?

Antipsychotics e.g haloperidol

30

Which class of drug is only used if necessary in agitated delirium patients?

Benodiazepines

Sedation lasts for a while, tends to worsen delirium