1
Q
Delirium
general and Sx
A
- waxing & waning level of consciousness w/ rapid onset
- rapid decrease in attention span + level of arousal
- key sx: disorganized thinking, hallucinations (often visual), sleep disturbances, cognitive dysfunction, agitation
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2
Q
Delirium
Screening
A
- clinical
- EEG: abrnomal in delerium (normal in dementia)
CRAM
- evalates for 4 fundamental features of delerium
- acute onset & fluctuating course, inattention, disorganized thinking, or altered LOC
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3
Q
Delirium
Tx
A
- correct underlying cause (tx infection, assisted withdrawal)
- maintain O2 levels, treat pain, maintain hydration
- calm, quiet environment for recovery
- Haloperidol (PRN- tx psychotic symptoms)
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4
Q
Delirium
Pearls
What to avoid
A
- reversible (esp anti-cholinergics)
- usually secondary to other illness or stressors (CNS diseases, infection, trauma, substance abuse/withdrawal)
on boards: often is post-op development of fever w/ associated infection
avoid benzodiazepines, can worsen psychotic sx
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5
Q
Dementia
General and Sx
A
- progressive decline in cognition and motor function w/ normal level of consciousness
- key sx: memory loss/deficits, impaired judgement, personality changes, loss of motor function (late stages)
- seen in elderly pts
- irreversible disease progress
Types
- Alzheimer’s (60%)
- Infarction (20%- caused by stroke)
- Lewy Body (Parkinson Disease)
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6
Q
A
clinical (but screen for other causes of memory loss like depression, hypothyroidism, HIV, vitamin deficiencies)
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7
Q
Narcolepsy
general and Sx
A
- excessive daytime sleepiness despite being awake and well-rested
- hypnagogic hallucination (just before going to sleep) and hyponopompic hallucinations (just before awakening)
- sleep paralysis (nocturnal & narcoleptic sleep episodes that begin w/ REM sleep)
- cataplexy (loss of all msk tone following strong emotional stimuli)
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8
Q
Narcolepsy
Criteria
A
- recurrent episodes of rapid onset, overwhelming sleepiness >3x wkly for the last 3 mo
- due to decreased orexin (hypocretin) production in lateral hypothalamus & dysregulated sleep-wake cycles
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9
Q
Narcolepsy
Tx
A
good sleep, daytime stimulants (amphetamines) or nighttide sodium oxybate (GHB)
Modafinil: non-amphetamine CNS stimulant to promote wakefulness (first line)
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10
Q
Stages of sleep
A
lack of sleep can cause exhaustion, drowsiness, axnxiety, depression, physiological impacts (cardiac, metabolic)
Stages
N1: lightest; theta waves; least amount of sleep occurs here
N2: medium; theta complexes (K-complexes + sleep spindle); bruxism (teeth grinding); largest percentage of sleep
N3: deepest sleep; delta waves; sleep walking, enuresis occurs here; night terrors
REM: dreams/nightmares; sawtooth pattern; penile tumescence
Cycles: NREM cycle is usually 90min; more cycles = longer REM
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11
Q
Sleep Terror Disorder
general and Sx
A
periods of inconsolable terror w/ screaming in the middle of the night
no memory of arousal episode
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12
Q
Sleep Terror Disorder
triggers
A
emotional stress, fever, lack of sleep
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13
Q
Sleep Terror Disorder
Tx
A
usually self limiting
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14
Q
Malingering Disorder
general
A
fake/exaggerate sx
consciously falsified medical symptoms
usually done for secondary external gain (worker’s compensation, opioids)
watch for poor compliance w/ tx or follow up of dx tests
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15
Q
malingering
Tx
A
ends when secondary gain is achieved
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16
Q
Munchausen Syndrome/Factitious Disorder
A
fake/exaggerated sx
Key: frequent stays in hospital, reluctance to allow Drs to talk to friends/families, conditions worsening despite tx or for no reason, inconsistent sx, extensive knowledge of medical terms/diseases
- by proxy: fake/exaggerated sx imposed on others (caregiver falsifies medical sx) ABUSE; MANDATORY REPORT
- factitious disorder imposed on self
- unconsciouslly falsified medical symptoms
Risk Factors: female gender, unmarried, prior or current HCP
17
Q
Munchausen Syndrome/Factitious Disorder
Tx
A
NOT SELF LIMITING (usually have significant hx of getting medical tx)
18
Q
Somatic Symptom Disorders
general
A
present for 6+ mo
1+ physical sx that cause distress (but normal HPI/PE)
can lead to dysfunctional thoughts, feelings, or behaviors associated w/ physical sx (like MDD)
can co-occur w/ medical illnes
unconscious, unintentional sx
Risk Factors: female gender, lower SES, lower education, ethnic minority
19
Q
Somatic Symptom Disorders
Tx
A
regular office visits w/ same PCP along with psychotherapy
20
Q
Pain Disorder
General
A
characterized by chronic pain causing significant distress or impairment
psychologic factors appear to worsen pain
unconscious, unintentional sx
Risk Factors: female gender, lower SES, lower education, ethnic minority
21
Q
Pain Disorder
tx
A
regular office visits w/ same PCP along with psychotherapy
22
Q
Illness Anxiety Disorder
general
A
present for 6+ mo
hypocondriasis
excessive care/worry about having or acquiring a serious illness leading to dysfunctional behaviors associated w/ health
constant check ups
minimal somatic sx (no physical findings)
unconscious, unintentional sx
Risk Factors: female gender, lower SES, lower education, ethnic minority
23
Q
Illness Anxiety Disorder
Tx
A
regular office visits w/ same PCP along with psychotherapy
24
Q
Conversion Disorder
general
A
Functional Neurologic Symptom Disorder
loss of sensory/motor function w/out affecting day to day function (paralysis, blindness, mutism, seizures)
often follows acute stressors
la belle indifference (indifferent to the loss of sensory/motor function, so does not affect day to day function)
unconscious, unintentional sx
Risk Factors: female gender, lower SES, lower education, ethnic minority
25
Q
Conversion Disorder
tx
A
regular office visits w/ same PCP along with psychotherapy
