Flashcards in liaison psychiatry Deck (53)
what is liaison psychiatry
link between general medicine and psychiatry in hospital setting
what is delirium?
an acute confusional state
what disturbances are seen in delirium?
1. consciousness and attention
5. psychomotor behaviour
7. sleep-wake cycle
duration of delirium
onset of delirium
what is the core feature of delirium?
delirium and future cognitive decline?
how does delirium affect outcomes?
worsens and increases mortality rates
RFs for delirium?
9. sensory impairment
causes of delirium?
I WATCH DEATH
Acute metabolic syndrome
Deficiency - thiamine, anoxia
Endocrine - hypo/erthyroid, cushings, addisons
Toxins/drugs - CO, steroids, opiates, digoxin
Heavy metals - lead, mercury
workup for delirium
1. med = psych hx
2. collateral hx
ix for delirium?
assessment scales for delirium?
attention assessments for delirium
MBT - months of the year backwards
days of the week backwards
count from 20 to 1
SAVEAHAART - >2 errors = fail, squeeze hand at A
environmental mangt delirium?
2. family involvement
3. reorientate frequently
4. environmental cues - clock/calendar
5. lighting for time of day
6. give glasses, hearing aid
7. mobilise and ADLs
8. 1:1 nursing
9. stop unnecessary meds
10. treat pain, constipation, dehydration etc
11. meds - not 1st line
meds in delirium?
antipsychotics may reduce duration
not 1st line
indications for meds in delirium?
1. patient distress
2. risk harm to patient/others
3. v disturbed sleep
4. significant behavioural prob
what is a conversion disorder?
thoughts or memories that are unacceptable are repressed and converted into physical symptoms
what is a dissociative disorder?
condition involving breakdown of memory, awareness, identity or perception - defense mechanism that is pathological and involuntary
examples of dissociative disorder?
1. dissociative amnesia
2. dissociative fugue
3. trance and possession disorder
4. dissociative motor disorders - paralysis, aphonia
5. dissociative convulsions
6. dissociative anaesthesia and sensory loss
7. other eg ganser syndrome
DSM vs ICD 10 dissociative and conversion
DSM - conversion = motor or sensory deficit, diss = function of consciousess disturbance
ICD10 - use both synonymously, prefer diss.
cause of DDs?
2. traumatic events
what do sufferers hope to gain from DDs?
onset and offset of DDs?
how long do DDs last?
weeks - months max
features of dissociative convulsions?
1. non epileptic but commonly in those with epilepsy
2. usually an audience
3. no injury when fall
4. don't bite tongue or incontinent
5. general shaking, not tonic clonic
6. no post ictal confusion or raised prolactin
7. usually a stressor
how are DDs diagnosed?
1. clinically inconsistent signs
2. exclude organic dz
3. demonstrate function thought to be absent
4. convincing psych explanation
1. supportive psychotherapy
2. explain initially organic sx but now due to maladaptive response
4. tx comorbid psych prob