The disturbed pt Flashcards
Example of organic mental DO
acute organic brain syndrome ______
chronic organic brain syndrome _____
(delirium)
dementia
Psychoactive and substance use disorders
1
2
3
- toxic states
- drug dependency
- withdrawal states
_____ affects 15% of people over 65 and can mimic or complicate any other illness, including delirium and dementia.
Depression
The diagnosis of dementia can be overlooked: a Scottish study showed that _____of demented patients were not diagnosed by their GP
80%
The key feature of dementia is
impaired memory
Hallucination guidelines: —\_\_\_\_\_\_ psychoses e.g. schizophrenia — \_\_\_\_\_: almost always organic disorder — \_\_\_\_\_ temporal lobe epilepsy — \_\_\_\_\_ cocaine abuse, alcohol withdrawal
Auditory:
Visual
Olfactory:
Tactile:
A term used for both senile and presenile dementia, which has characteristic pathological degenerative changes in
the brain.
AD
The mental functions of perception, thinking
and memory. It is the process of ‘knowing’.
cognition
Repeated, stereotyped and seemingly
purposeful actions that the person feels compelled to carry out but resists, realising they are irrational (most are associated with obsessions).
Compulsion
Disorientation in time, place and person. It
may be accompanied by a disturbed conscious state
Confusion
The process by which thoughts or
experiences unacceptable to the mind are repressed and converted into physical symptoms.
Conversion
also termed ‘toxic confusional state’)
A relatively acute disorder in which impaired
consciousness is associated with abnormalities of perception or mood
Delirium
Abnormal, illogical or false beliefs that are
held with absolute conviction despite evidence to the
contrary.
Delusions
An acquired, chronic and gradually
progressive deterioration of memory, intellect and personality.
Dementia
______ or early onset dementia is dementia under 65 years of age.
______refers to older patients (usually over 80 years
Presenile dementia
Senile dementia
A psychological disorder in which
unpleasant memories or emotions are split off from consciousness and the personality and buried into the unconsciousness
Dissociation
An alteration in the awareness of
the self—the person feels unreal.
Depersonalisation
Disorders of perception quite divorced
from reality
Hallucinations
False interpretations of sensory stimuli such
as mistaking people or familiar things.
Illusion
Recurrent or persistent thoughts, images
or impulses that enter the mind despite efforts to exclude them
Obsessions
The conversion of mental experiences
or states into bodily symptoms, with no physical causation.
Somatisation
The sudden onset of delirium may suggest
1
2
3
angina, myocardial infarction or a cerebrovascular accident
In the elderly in particular, fluid and electrolyte
disturbances, such as dehydration, ___________, can cause
delirium
hypokalaemia, hyponatraemia and hypocalcaemia
Sedation:
Avoid intramuscular ____ because of poor absorption.
diazepam
Be cautious of intravenous _____
(Hypnovel) in such patients because of the risk of respiratory depression
midazolam
Avoid benzodiazepines in patients with
respiratory insufficiency. ______ is an
alternative
Haloperidol
Adverse effects of sedatives:
• respiratory depression
• hypotension
________
_______
- dystonic reactions, including choking
* neuroleptic malignant syndrome
Benzodiazepines are generally the drugs of first choice over antipsychotics in _______
tranquillisation
Oral BZD sedatives:
Oral medication
diazepam 5–20 mg (o), repeated every 2–6 hours (max: 120 mg/24 hours)
or
lorazepam 1–2 mg (o), repeated every 2–6 hours (max: 10 mg/24 hours
If sedation is not achieved with DZP and Loraz, add an antipsychotic medication e.g.
olanzapine 5–10 mg initially or
risperidone 0.5–1 mg initially
______is similar to
haloperidol but more sedating
Droperidol
SE with Droperidol
potentially fatal laryngeal dystonia with high
doses
How to manage acute dystonia with Droperidol
benztropine 2 mg IM.)
Diagnosis of delirium requires evidence of:
A________
B________
C A change in cognition: • perceptual disturbance • incoherent speech • disorientation • memory impairment/deficit
D A & C not better explained by another disorder
E Evidence of a cause
A Disturbance of consciousness, attention and
awareness
B Clinical features appearing over a short period
Delirium cause
Features include hyperactivity, marked thought disorder, vivid visual
hallucinations and very disturbed behaviour
Anticholinergic delirium
Consider alcohol withdrawal and give a trial of_______when the cause of delirium is unknown
thiamine
Delirium Mx:
For psychotic behaviour
1
2
haloperidol 0.5 mg (o) as a single dose
or
olanzapine 2.5–10 mg (o) daily in 1 or 2 doses
Delirium Mx:
If oral administration is not possible or when
parenteral medication is required (cover with
benztropine 2 mg (o) or IM):
haloperidol 0.5 mg IM as single dose
or
olanzapine 2.5 mg IM as single dose
Delirium Mx:
For anticholinergic delirium:
tacrine hydrochloride 15–30 mg with caution by
slow IV injection (an antidote
______ is the presence of the mental state where appreciation of reality is impaired as evidenced by the presence of typical psychotic symptoms such as delusions, hallucinations, mood disturbance and
bizarre behaviour
Acute psychosis
DSM for Schiz
Two or more of following, each present for a
significant portion of time during a one-month period
1
2
3
4
5
1 delusions 2 hallucinations 3 disorganised speech 4 grossly disorganised or catatonic behaviour 5 negative symptoms e.g. flat effect
refers to a group of severe psychiatric illnesses characterised by severe disturbances of emotion, language, perception, thought processes, volition and motor activity
Schizophrenia
Positive Sx of Schiz
— delusions
— hallucinations
— thought disorder
— disorganised speech and behaviour
Negtaive Sx of Schiz
— flat affect — poverty of thought — lack of motivation — social withdrawal — reduced speech output
Cognitive Sx of Schiz
— distractibility
— impaired working memory
— impaired executive function (e.g. planning)
— impaired insight
Mood DO of Schiz
— mania (elevation)
— depression
Drugs associated with Schiz
- amphetamines
- hallucinogens (e.g. LSD)
- marijuana
How to start of antipsychotic in Schiz
Start with a low dose and titrate upwards at a rate and to a level that is optimal for the
patient. Patients with a first psychotic episode may respond to lower than usual doses.
First line of anti psychotics 1 2 3 4 5 6 7 8 9
amisulpride 100 mg nocte asenapine 5 mg sublingual bd aripiprazole 10 mg once daily olanzapine 5 mg nocte paliperidone 3 mg once daily quetiapine 50 mg bd → 200 mg bd (by day 5) risperidone 0.5–1 mg nocte → 2 mg nocte sertindole 4 mg (o) once daily ziprasidone 40 mg bd → 80 mg bd
Options If no response after 4–6 weeks
• an alternative second-generation agent
or
• a first-generation antipsychotic such as:
chlorpromazine 200 mg once daily → 500 mg
haloperidol 1.5 mg once daily → 7.5 mg
trifluoperazine 2 mg bd
