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Psychiatry > Psychiatric Complications of Physical Disorders > Flashcards

Psychiatric Complications of Physical Disorders Flashcards

1
Q

What is the most common mental health problem in hospitalized patients over 65?

A

Delirium

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2
Q

What is the mean prevalence of delirium?

A

20%

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3
Q

Diagnostic criteria for delirium?

A 
Impairment of consciousness
Disturbance of cognition
Psychomotor disturbance
Disturbance of sleep-wake cycle
Emotional disturbance
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4
Q

What is included in impairment of consciousness seen in delirium?

A

Clouding
Drowsiness
Sopor
Coma (GCS)

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5
Q

What is included in disturbance of cognition in terms of delirium?

A

Disorientation for time but sometimes place and person too
Impaired memory and attention
Impaired thinking
Perceptual disturbance, visual hallucinations and illusions

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6
Q

What psychomotor variants are seen in delirium?

A

Hyperactive
Hypoactive
Mixed

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7
Q

Describe hyperactive delirium

A 
Elderly (+/- cognitive impairment) 
Recent injury 
Sudden onset new confusion, agitation, restlessness
Sundowning fluctuation 
Disruptive behaviour
Delusions/ hallucinations of persecution
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8
Q

Describe hypoactive delirium

A 
Suddenly quiet, withdrawn and sleepy
Fluctuates throughout the day 
Doesn't eat, drink, tend to personal care
Not engaging in rehab
Often misdiagnosed as depression
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9
Q

What sleep disturbance is seen in delirium?

A 
Insomnia
Sleep loss
Reversal of sleep cycle
Nocturnal worsening of symptoms; sundowning
Disturbing dreams and nightmares
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10
Q

What affective disturbances are seen in delirium?

A 
Depression 
Anxiety
Fear
Irritability
Euphoria
Apathy
Perplexity
Aggression
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11
Q

What are the general features of delirium?

A

Rapid onset
Transient and fluctuating course
Lasts days to months depending on underlying cause

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12
Q

Causes of delirium?

A 
Everything 
Cardiovascular disorders; intracranial/ subdural bleed, MI, PE, cardiac failure 
Resp: hypoxia
GI; liver failure, pancreatitis 
Endocrine: diabetes, thyroid 
Infections 
GU; UTI, renal failure
Intoxication: alcohol, drugs 
Neurological: head injury, meningitis, encephalitis, tumour, epilepsy
Trauma; accidental or surgical
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13
Q

What drugs are commonly implicated in delirium?

A 
Anticholinergic agents
Anticonvulsants
Anti-parkinson's drugs
Steroids
Cimetidine
Opiates
Sedatives 
Withdrawal from alcohol and illicit drugs
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14
Q

Metabolic causes of delirium

A 
Hypoxia
Hypoglycemia
Compromised liver/ kidney function 
Deranged fluid/ electrolyte balance
Hypo/ hyperthyroidism
Hypopituitarism
Hypo/ hyperparathyroidism
Porphyria
Carcinoid syndrome
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15
Q

Risk factors for development of delirium

A 
Elderly 
Cognitive coexisting dementia
Existing sensory deficits
Previous episode
Perioperative; long or emergency surgery 
Extremes in sensory experience; hypo/hyperthermia
Immoblity
Social isolation 
New environement
Stress
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16
Q

Investigations in a new presentation of delirium?

A 
History and full physical
Formal cognitive test 
Urinalysis 
FBC, U&Es, LFTs
Thyroid function 
BG
CRP 
B12 and folate 
CXR
MRI/ CT brain 
Consider EEG
17
Q

What will be seen on EEG of someone suffering from delirium?

A

Diffuse background slow-wave activity

18
Q

What cognitive assessment is used to diagnose delirium?

A 
4AT; 
Alertness
Orientation (4AMT; age, DOB, place, current year) 
Attention; years backwards
Acute change or fluctuating course
19
Q

Management of delirium

A

Identify and treat cause
Manage environment and provide support
Prescribe
Review

20
Q

How should the environment be managed to help those with delirium?

A

Reality orientation; clear communication, clock, calendar
Correct sensory impairment; bring in glasses, hearing aids etc
Bright side room, reduce unnecessary noise
Ensure basic needs met; food, water, warmth

21
Q

Should you instantly prescribe in delirium?

A

No; sedating drugs can worsen delirium by increased confusion and unsteadiness, consider practical management first

22
Q

What is 1st line in treatment of agitation in delirium?

A

Haloperidol 0.5-5mg PO the IM up to 10mg in 24 hours

23
Q

2nd line in treatment of delirium?

A

Lorazepam; 0.5-2mg up to 2x in 24 hours

24
Q

How long does delirium tend to last?

A

1-4 weeks

Can be longer in elderly

25
Q

How many post stroke patients have a major depression?

A

Up to 1/3rd

26
Q

How many patients post MI have depressive symptoms?

A

65%

Psychiatry (35 decks)

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