4.1 Psychiatric complications of physical disorders Flashcards Preview

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Flashcards in 4.1 Psychiatric complications of physical disorders Deck (16):
1

What are the typical features of delirium?

Impaired consciousness
Disturbed cognition
Psychomotor disturbance
Disturbed sleep-wake cycle
Emotional disturbance

Generally these features are rapid onset, transient and fluctuating, and may last days to months

2

What is the differential diagnosis of delirium?

Depression
Dementia
Post-stroke depression
Post-MI depression

3

What is the non-pharmacological management of delirium?

Tx cause
Manage environment
1. educate and raise awareness in staff
2. orient pt, clock, calendar, clear communication
3. Correct sensory impairments- glasses, hearing aids
4. Keep in bright side room, no unnecessary noise, remove unsafe objects
5. Ensure basic needs food/warmth/water met

4

What is the pharmacological management of delirium?

If alcohol withdrawal- reducing scale of diazepam or chlordiazepoxide

Otherwise: haloperidol 0.5-5mg in elderly - orally, then IM, max 10mg/24 hours

PARKINSONS, LEWY BODY DEMENTIA, NEUROLEPTIC SENSITIVITY: give LORAZEPAM 0.5-2mg up to 2x in 24H

Review frequently

5

What is delirium?

Impaired consciousness with intrusive abnormalities of perception and affect

6

What is the spectrum of impaired consciousness?

Common features of delirium:
Impaired consciousness
Disturbed cognition
Psychomotor disturbance
Disturbed sleep-wake cycle
Emotional disturbance

Alert
Clouding
Drowsy
Sopor- abnormally deep sleep
Coma- GCS

7

What does disturbed cognition mean?

Common features of delirium:
Impaired consciousness
Disturbed cognition
Psychomotor disturbance
Disturbed sleep-wake cycle
Emotional disturbance

Disorientation for time- but may be: place and person
Impaired memory and attention
Impaired thinking
Perceptual disturbance- hallucinations and illusions- Often visual in delirium

8

What is psychomotor disturbance?

Common features of delirium:
Impaired consciousness
Disturbed cognition
Psychomotor disturbance
Disturbed sleep-wake cycle
Emotional disturbance

Hyperalert/hyperactive: agitation, hallucinations, aggression
Hypoalert/hypoactive: confusion, sedation, depression is ddx
Mixed: flux

9

What are types of sleep disturbances?

Common features of delirium:
Impaired consciousness
Disturbed cognition
Psychomotor disturbance
Disturbed sleep-wake cycle
Emotional disturbance

Insomnia
Sleep loss
Reversal of sleep cycle
Nocturnal worsening symptoms- sundowing
Disturbing dreams and nightmares

10

What are types of emotional disturbances?

Common features of delirium:
Impaired consciousness
Disturbed cognition
Psychomotor disturbance
Disturbed sleep-wake cycle
Emotional disturbance

'depression'
anxiety
fear
irritability
euphoria
apathy
perplexion
aggression

11

What are main causes of delirium?

CVS: intracranial bleeds, MI, PE, cardiac failure
Resp: hypoxia
GI: liver failure, pancreatitis
Endo: diabetes or thyroid complication
Infection
GU: UTI, renal failure
Drugs: alcohol, drugs, rx drugs, withdrawal
Neuro: head injury, meningitis, encephalitis, tumours, epilepsy
Trauma: accident, sx
Neoplastic

12

What are major drug causes of delirium?

Alcohol
Illicit drugs
anticholinergics
anticonvulsants - epilepsy
antiparkinsonian - parkinson's
steroids
cimetidine
opiates
sedatives

13

Withdrawal from which drugs may cause delirium?

Alcohol
Sedatives, benzodiazepines
Barbiturates
Illicit drugs

14

Which metabolic states may cause delirium?

Hypoxia
hypoglycaemia
Liver/kidney disfunction
fluid/electrolyte imbalance
thyroid hormone imbalances
hypopituitarism
parathyroid imbalances
porphyria
carcinoid syndrome

15

Risk factors for delirium?

Elderly age
Dementia or cognitive deficit
Sensory deficits of blindness or deafness
Previous episode
Long sx or emergency sx
Extremes of temperature
Immobile
Social isolation
New environment
Stress

16

Which investigations may be appropriate in delirium?

Hx
Physical examination
Formal cognitive tests: MMSE, CAM, ACE-R, MoCA
urine analysis
FBC, U/E, LFT, TFT, glucose, CRP, B12, Folate
CXR
MRI/CT brain
?EEG - may show diffuse background slow wave activity