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15 Cards in this Set
- Front
- Back
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Discuss DT's
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5% of withdrawal cases with 5% mortality rate.
Occurs 48-96 hors post witdrawal: autonomic activation including diaphoresis, fever, tremor, tachycardia, hypertensive crisis, delerium with loss of consciousness |
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List 3 organic causes of psychosis
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delerium
dementia metabolic -thyroid, electrolytes, hepatic encephalopathy, renal failure |
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What are the elements of a mental state examination
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appearance
behaviour speech mood thought - process and content perception orientation insight judgement cognition |
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How is delerium different to dementia
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Acute and fluctuating level of consciousness (hypo, hyper or mixed level of activity), perceptions (distractability, delusions, hallucinations, abnormal behaviour, movenents, speech) and cognition (memory, orientation, perceptial clarity). Dementia doesn't fluctuates and isn't acute.
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Whqt are the aetiologies of delerium
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Primary cerebral disease, secondary effects (metabolic encephalopathy, sepsis), substance intoxication (can be prescription drugs in demented patients) and witdrawal
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What are the hx and ex for
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Hx of pre morbid state
MSQ, MSE if less acute Neurological exam CNS exam Investigations (fbc, u&e, glucose, lft, alcohol, vitals) plus brain imaging |
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What are the levels of attention and concentration
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arousal (use GCS)
divided alternating (be able to do 2 tasks) selective sustained |
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A doctor orders benzo's, a TCA and benztropine plus restrains for a delerious patient. What would you tell him
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Mobilise and use appropriate stimulation (eg radio, music, low lighting, engage in conversation)
Minimise overstimulation Promote normal circadian rhythm Correct hydration Simplify to minimise confusion and over stimulation: single room, single nurse, relative present Avoid anticholinergics - worsens cognition. Avoid benzos. |
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What are the criteria for dementia
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Impaired memory for new learning and abnormal thinking that interferes with ADL's (basic and instrumental)
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Other than memory, what other symptoms are present in dementia
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language (not able to name things)
visual construction praxis Executive function (planning activities such as working out a new route) |
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A patient is concerned about feeling down, loss of concentration and a MSE shows loss of social and occupational function, loss of insight, disinhibition, mental inflexibility, loss of personal care. What are the ddx
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frontal lobe temporal dementia
Lewey body dementia, Alzheimes's, dementia depression, dysthymia, bipolar, early schitzoaffective |
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On the Hachinski vascular dementia scale, what are the stand out signs differentiating this from AD
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Hx of CVS
Fluctuating symptoms Focal symptoms |
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What are the 4 elements of a CAM tool assessment
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The confusion assessment measurement tool mus have 1+2 plus 3 or 4
1) Acuteness of onset 2) Inability to concentrate (eg serial 7's) and memory impairment (3 objects) 3) Disorganised thinking: rambling, tangential responses, unclear or illogical speech 4) Altered level of consciousness: hypervigilent, lethargic, stupor |
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What are the pharmacotherapeutic approaches to delirium
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1) Avoid anticholinergics (1st gen psychotropics, tricyclics)
2) Rationalise number of drugs 3) Administer drugs to control "sundowning" deterioration 4) 1-5mg haloperidol (0.25-0.5 in elderly) orally. IM if necessary 5) If haloperidol isn't tolerated (eg Parkinsonism) then 0.5-2mg risperidone or 2.5-10mg olanzapine |
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List non pharmacological aids in managing delirium
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adequate hydration and nutrition
analgesia promotion of sleep correction of visual and hearing impairments avoidance of restraints provision of lighting appropriate to the time of day quiet use of single rooms minimal staff changes memory and orientation aids such as availability of a clock and calendar close involvement of family members |
