1: Psychiatric complications of physical disorders (mainly delirium) Flashcards Preview

Psychiatry Week 4 2018/19 > 1: Psychiatric complications of physical disorders (mainly delirium) > Flashcards

Flashcards in 1: Psychiatric complications of physical disorders (mainly delirium) Deck (37)
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1
Q

What are the CAM criteria for delirium?

A

1. Inattention

2. Disordered thinking AND/OR Change in conscious level

3. Acute onset and fluctuating course

2
Q

What sorts of cognitive disturbances may delirious patients experience?

A

Impaired memory and attention

Thought disorder

Perceptual changes (hallucinations)

Disorientation (time, space, person)

3
Q

What are the two terms used to describe a patient’s psychomotor state?

A

Hyperactive (agitation)

Hypoactive (retardation)

OR it could be a mixed picture

4
Q

What is psychomotor retardation often misdiagnosed as?

A

Depression

5
Q

What sort of hallucinations are seen in organic problems?

A

Visual hallucinations

6
Q

What sort of hallucinations are seen in primary psychiatric illness?

A

Auditory hallucinations

7
Q

What is “sundowning” in the context of delirium?

A

Tendency for symptoms to worsen at night

So patients spend the day asleep and are awake (and often agitated) at night

8
Q

Which mood disorder is often misdiagnosed in delirious patients?

A

Depression

due to psychomotor retardation, sedation, apathy

9
Q

Do you need to have an identified cause of delirium to be officially diagnosed?

A

No

Underlying cause may have gradual onset or be in subclinical phase

Delirium is a clinical diagnosis

10
Q

What is the usual

a) onset
b) course
c) duration

of delirium?

A

a) Acute onset
b) Fluctuating course
c) Weeks to months

11
Q

What are the causes of delirium?

A

Virtually any disease

12
Q

Which group of patients is more susceptible to delirium?

A

Frail patients with co-morbidities

which tends to be the elderly

13
Q

Apart from diseases, what can cause delirium?

A

Drugs

14
Q

Which therapeutic drugs can precipitate delirium?

A

Anticholinergics

Anticonvulsants

Drugs used for PD - levodopa, dopamine agonists

Steroids

15
Q

Which recreational drugs can precipitate delirium?

A

Alcohol

Illicit drugs

16
Q

Use of drugs can cause delirium.

What else can precipitate it?

A

Withdrawal from drugs

alcohol, opiates, benzos

17
Q

Any significant ___ to the body can precipiate delirium.

A

insult

18
Q

How is delirium diagnosed?

A

Clinically

based off CAM criteria

19
Q

What age of patient is predisposed to developing delirium?

Why?

A

Elderly

Frail, more likely to have existing comorbidities

20
Q

A past psychiatric history of which illnesses predisposes a patient to delirium?

A

Delirium

Dementia

21
Q

Sensory ___ (e.g hyper/hypothermia) and ___ (e.g deafness, blindness) can precipitate delirium.

A

Sensory extremes and deficits

22
Q

After which intervention are patients particularly vulnerable to delirium?

A

Surgery

Perioperative period where patient is recovering

23
Q

Exposing a frail elderly patient to a new ___ may precipitate delirium.

A

new environment

24
Q

Apart from history and examination, how would you assess a patient’s cognitive function?

A

Formal cognitive testing

so 4AT, MOCA, ACE-III

25
Q

How can the environment of a patient with delirium be improved to prevent unneccessary distress?

A

Well lit, quiet

Orienting factors (e.g a clock, 24H news)

Minimise staff changes

Remove unneccessary equipment

26
Q

Which renal investigation should be done in patients with delirium?

A

Urinalysis

to exclude UTI

27
Q

Which blood tests should you request for a delirious patient?

A

FBC, WCC and inflammatory markers

LFTs and TFTs

Blood glucose

Vit B12 and folate

28
Q

Why must you do a urinalysis for a delirious elderly patient?

A

UTI is a common cause of delirium in the elderly

29
Q

What is the standard pharmacological management for delirium?

A

Antipsychotics e.g haloperidol

30
Q

Which class of drug is only used if necessary in agitated delirium patients?

A

Benodiazepines

Sedation lasts for a while, tends to worsen delirium

31
Q

What is the mean duration of delirium

a) in younger patients
b) in older patients?

A

a) 1-4 weeks in young patients

b) 4-6 weeks in older patients

32
Q

Which class of drug is used to sedate patients during alcohol withdrawal?

Can you name the specific drug?

A

Benzodiazepines

Chlordiazepoxide

33
Q

Under NHS Tayside delirium guidelines, which drug is used to treat delirium

a) in your average patient
b) in patients with Parkinson’s disease or dementia with Lewy bodies?

A

a) Haloperidol
b) Lorazepam

34
Q

Name a benzodiazepine which has a

a) short duration
b) long duration?

A

a) Lorazepam

b) Diazepam

35
Q

Which cardiovascular diseases carry a significant risk of patients developing depression?

A

Stroke

MI

36
Q

Which percentage of stroke patients develop depression?

A

33%

one third

37
Q

Which percentage of MI patients develop depression?

A

20%