Approach - Disturbed behaviour Flashcards Preview

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Flashcards in Approach - Disturbed behaviour Deck (9)
1

Describe schizophrenia
- positive symptoms
- negative symptoms
- cognitive symptoms
- functional symptoms
- impaired insight

–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

2

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

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•patients appear quiet and withdrawn and may be misdiagnosed as depressed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

3

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

Increased age

Pre-existing cognitive deficits:
-Dementia
-Past cerebral damage

Polypharmacy Sensory impairment &/or deprivation

Multiple chronic medical conditions

4

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

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

5

How do you diagnose delirium?

by CAM (Confusion assessment method)

Dx of delirium requires both:
- Acute onset and fluctuating course
- Inattention

AND
- Disorganised thinking
OR
- Altered conscious state

6

Describe dementia
- cognitive deficits
- non cognitive deficits
- BPSD

–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”

7

Interpret the score of MMSE

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

8

DDx of dementia

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

9

Compare & contrast delirium from dementia
- onset
- duration
- presence of other disorders/physical problems
- variation at night
- attention
- level of consciousness
- memory
- need for Rx

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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