Approach - Disturbed behaviour Flashcards

1
Q

Describe schizophrenia

  • positive symptoms
  • negative symptoms
  • cognitive symptoms
  • functional symptoms
  • impaired insight
A

–Positive symptoms: delusions, hallucinations, disorganisation
–Negative symptoms: affective blunting, anhedonia, amotivation/avolition, poor self care, social withdrawal, alogia
–Cognitive symptoms: executive dysfunction, memory, other
–Functional symptoms: work/study, relationships/family, personality
–Impaired insight: illness, treatment, impact etc

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2
Q

Describe 3 types of delirium (in terms of its activity)

A
  1. Hyperactive delirium ~ 30%
    •easily recognised
    •repetitive behaviours (e.g. plucking at sheets), wandering, hallucinations or verbal and physical aggression
  2. Hypoactive delirium ~ 25%
    •easily missed
    •patients appear quiet and withdrawn and may be misdiagnosed as depressed
  3. Mixed pattern ~ 45%
    •fluctuates and includes lucid periods
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3
Q

List predisposing factors for delirium (c.f. precipitating factors)

A

Increased age

Pre-existing cognitive deficits:

  • Dementia
  • Past cerebral damage

Polypharmacy Sensory impairment &/or deprivation

Multiple chronic medical conditions

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4
Q

List (6) types of precipitating factors for delirium & their examples (c.f. predisposing factors)

A
  1. Medications: intoxication, action, side effects & interactions
  2. Severe/multiple medical problems:
    - Infection/sepsis
    - Metabolic encephalopathies
    - Dehydration/poor nutrition
    - Electrolyte imbalance
    - Organ failure
    - Hypoxia
    - Fever/hypothermia
  3. Surgery & anaesthetics: especially emergency, lengthy & orthopaedic procedures
  4. Substance withdrawal: especially alcohol & benzodiazepines
  5. Acute brain pathology
  6. Environmental aspects:
    - Disturbed sleep
    - Urinary catheter
    - Pain & discomfort
    - Unfamiliar environment
    - Immobility
    - Restraints
    - Absence of sensory aids

Precipitating factors must be treated to treat delirium

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5
Q

How do you diagnose delirium?

A

by CAM (Confusion assessment method)

Dx of delirium requires both:

  • Acute onset and fluctuating course
  • Inattention

AND
- Disorganised thinking
OR
- Altered conscious state

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6
Q

Describe dementia

  • cognitive deficits
  • non cognitive deficits
  • BPSD
A

–Cognitive deficits include memory, executive function, language
–Non-cognitive deficits include mood and behavioural symptoms, often referred to as BPSD

  • BPSD: behavioural and psychological symptoms of dementia

“symptoms of disturbed perception, thought content, mood or behaviour that frequently occur in patients with dementia”

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7
Q

Interpret the score of MMSE

A

25-30 normal
21-24 mild cognitive impairment
14-20 moderate cognitive impairment

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8
Q

DDx of dementia

A
  • Alzheimer’s Disease
  • Other dementias (Frontal lobe dementia, Creutzfeldt-Jakob disease, HIV, alcohol)
  • Dementia with Lewy bodies (PD, Diffuse Lewy Body disease)
  • Vascular dementias
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9
Q

Compare & contrast delirium from dementia

  • onset
  • duration
  • presence of other disorders/physical problems
  • variation at night
  • attention
  • level of consciousness
  • memory
  • need for Rx
A

Delirium:

  • sudden onset
  • days to weeks
  • other disorders/physical problems almost always present
  • almost always worse at night
  • impaired attention
  • fluctuating level of consciousness
  • jumbled & confused memory
  • emergency medical condition

Dementia:

  • slow onset
  • months to years
  • possibly no presence of other disorders/physical problems
  • often worse at night (“sundowning”)
  • attention maintained until late
  • normal level of consciousness until late
  • lost memory (esp recent)
  • non medical emergency
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