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Psychiarty lecture 2: NCD

What falls under NCDs:


Delirium.
Major or Minor Neurocognitive Disorders (Dementia)
Amnestic disorders.

Basics :
Cognition refers to tasks that include:
memory short/long term
language
orientation
judgment
problem-solving
planning
ability to have interpersonal relationships
praxis (perform actions)
The cognitive decline was not present from birth or very early in life
therefore represent a decline from a previously attained level of
functioning.
Agnosia: Failure to recognize familiar objects
Aphasia: Failure to produce of comprehend verbal speech
Apraxia: Failure to execute complex motor skills
Difficulty in EFx: Ability to think abstactly and diff with activities of
daily life.

Deliurium

Definition: acute decline in both the level of consciousness and


cognition with particular impairment in attention aka Acute
confusional state.

Predisposition/Risk factors :
Age(old age)
Psychiatric comorbidities (esp.mood disorders)
Sensory impairment (blind or deaf)
Nutritional problems: Malnutrition, anorexia etc etc
Drug intoxication/Dependance(alcohol any other drugs).
Surgical floor-Anesthics

Etiology :
Drugs Anticholinergics (codeine,Xanax, Chlorpheniramine),
Benzos,Heroin.
Dehydration
Infections- meningitis
CNS Seizures, Trauma
Endocrine- Diabetes
organ failure( cardiac, renal, hepatic),
hyper or hypoglycemia
Metabolic- acidosis/alkalosis Resp Failure, diabetes,

Classification:

Delirium due to another Medical Condition.


evidence from the history, physical examination, or laboratory
findings that the disturbance is attributable to the
physiological consequences of another medical
Delirium due to Medication Induced
Drug-induced delirium is very common amongst the elderly
Benzodiazepines.
Narcotic analgesics.
First-generation antihistamines-Damn allergex
Theophylline
Antispasmodics
Warfarin

Delirium due to Substance Intoxication
Alcohol
Cannabis
Phencyclidine
Other hallucinogen
Inhalant
Opioids
Amphetamines
Cocain
Delirium due to Substance Withdrawal
Delirium tremens
Insomnia and fatigue.
Tremor.
Mild anxiety/feeling nervous.
Mild restlessness/agitation.
Nausea and vomiting.
Headache.
Excessive sweating.
Palpitations.
Anorexia.
Depression.
Craving for alcohol.
Substances include- coffee , alcohol, cannabis etc etc .
Delirium due to Multiple Etiologies
More than one etiological medical condition; another medical
condition plus substance intoxication or medication side effect
Clinical Features
Usually acute or subacute presentation.
Fluctuating course.
Consciousness is clouded/impaired cognition/disorientation.
Poor concentration.
Memory deficits - predominantly poor short-term memory.
Abnormalities of sleep-wake cycle, including sleeping in the day.
Abnormalities of perception - eg, hallucinations or illusions.
Agitation.
Emotional lability.
Psychotic ideas are common but of short duration and of simple
content.

Subtypes :
Hypoactive subtype - apathy and quiet confusion are present and
easily missed. This type can be confused with depression.
Hyperactive subtype - agitation, delusions and disorientation are
prominent and it can be confused with schizophrenia.
Mixed subtype - patients vary from hypoactive to
hyperactive.
Assessment:
ABCs.
Conscious level.
Vital signs - eg, pulse oximetry, pulse, blood pressure, temperature.
Full cardiovascular and respiratory examination.
Full abdominal and genitourinary examination, if appropriate.
Full neurological examination.
Further examination depending on the suspected problem - eg, ENT
or rectal examination.
Treatment:
Supportive therapy
Clear communication.
Reminders of the day, time, location and identification of
surrounding persons.
Have a clock available.
Have familiar objects from home around patients, especially glasses,
walking aids and hearing aids.
Staff consistency - both doctors and nurses.
Relaxation - eg, watch television.
Involve the family.

Pharmacotherapy
Haloperidol or olanzapine are preferred, using the lowest possible
dose for the shortest possible time (normally a week or less).
In delirium resulting from alcohol withdrawal (delirium tremens), a
benzodiazepine such as diazepam or chlordiazepoxide is preferred.

Electroconvulsive therapy (ect)


treatment for delirium when other approaches have failed.
It has been used as a last resort for delirious patients with
severe agitation who are not responsive to
pharmacotherapy, such as high doses of iv haloperidol.