Liaison Psych and Delirium

Question 1

What is liaison Psychiatry?

Answer 1

• Sub-speciality within psych that provides psychiatric care to medical patients
• Includes those in A&E, general hospitals and outpatients
• Works on the significant and ever increasing association between medical and psychiatric health (25% of gen med patients have mental health needs. 15% of A&E attenders have a significant mental health problem).

Question 2

What can the liaison psych team do?

Answer 2

• Conduct assessment on the wards
• Offer therapeutic work to these patients
• Liaise with specialist, community psych teams
• Participate in safeguarding
• Do a lot of MHA and MCA work.

Question 3

What conditions are most commonly seen by the Liaison psych team?

Answer 3

• Self harm and suicidal thinking
• Acute crises in mental health
• Dementia
• Delirium
• Depression and Anxiety
• Health anxiety
• MUS
• Perinatal care
• Substance misuse

Question 4

What is involved in a liaison psych assessment?

Answer 4

• Review of medical notes, observations, blood results, medication review
• Reason for them being in hospital
• Mental health assessment, screen for medical or iatrogenic causes for psych symptoms
• Social circumstances e.g. degree of support, finances, family life, employment
• Risk assessment (to self, to others, of worsening mental health, of neglect)

Question 5

What are the three forms of Delirium?

Answer 5

• Hyperactive
• Hypoactive
• Mixed

Question 6

What are some common causes of delirium?

Answer 6

Medications:

• Analgesia
• Antihistamines
• Asthma
• Parkinson’s
• Anti-epileptics
• Steroids

Conditions:

• Substance use + withdrawal
• Almost any metabolic imbalance
• Infections (UTI, LRTI)
• Toxins (carbon monoxide)
• Malnutrition, Dehydration
• Pain
• Sleep deprivation
• Surgery

Question 7

What is the link between corticosteroids and psych?

Answer 7

CSs can induce severe psych disorders such as:

• depression
• bipolar disorders like hypomania
• psychosis
• insomnia
• anxiety
• panic attacks

Question 8

What are the 4 criteria needed to have capacity?

Answer 8

Be able to...
- Understand
- Retain
- Weigh up (n.b. most commonly failed section)
- Communicate
...a health related decision to be made.

Question 9

What medications most commonly interact with Lithium?

Answer 9

• NSAIDs
• Diuretics (affect electrolyte balance)
• Oral rehydration tablets

Question 10

What are the main predisposing factors for delirium?

Answer 10

• Aged 65+
• Pre-existing dementia
• Previous stroke
• Current hip fracture
• Sensory impairment e.g. sight or hearing loss
• Any severe illness with potential to deteriorate e.g. diabetes and CKD

Question 11

What are the potential underlying causes of delirium?

Answer 11

SMASHED:
- Sepsis (so look for UTI, LRTI etc)

• Meningitis and other CNS pathology (e.g. stroke, head injury)
• Alcohol and drug use and withdrawal
• Systems failure (e.g. renal, hepatic, respiratory, cardiac failure. GI obstruction, constipation, UR)
• Hypers and Hypos (hyper-glycaemia/ thermia/ thyroidism/. hypo- glycaemia/ thyroidism/ thermia/ oxia/ tension).
• Electrolyte derangement (Na, Ca, vitamin deficiencies such as Thiamine)
• Drugs (steroids, diuretics, SSRIs, opiates, benzos, B-blockers, lithium toxicity).