Common Psychiatric Disorders Discussion Paper
Mr. White is a 72-year-old man, with a history of hypertension, COPD and moderate dementia, who presents with 4 days of increased confusion, nighttime restlessness, visual hallucinations, and urinary incontinence. His physical exam is unremarkable except for tachypnea, a mildly enlarged prostate, inattentiveness, and a worsening of his MMSE score from a baseline of 18 to 12 today.
Mr. White’s presentation is most consistent with an acute delirium (acute change in cognition, perceptual derangement, waxing and waning consciousness, and inattention). Common Psychiatric Disorders Discussion Paper
Psychiatric Disorders
Delirium is serious and treatable condition that affects a person’s mental state. It is common in older hospitalized people, especially those diagnosed with dementia. The condition develops over a short period of time (within hours or days) and has fluctuating symptoms (Codling et al., 2021). Diagnosing delirium in patients suffering from dementia involves examining the patient’s clinical history, mental status, and determining how the disease’ symptoms developed overtime. The clinical history examines the patient’s medication history, including herbal remedies and over the counter drugs while the mental status test assesses the patient’s mental capability (Codling et al., 2021). It uses the 4AT tool to determine the patient’s
Healthcare practitioners can conduct further tests such as blood, urine sample, and chest-x-ray tests to determine the further cause of delirium and exclude pneumonia existence respectively (Janssen et al., 2019).
The treatment option to consider is addressing the medical problems that have caused the condition starting from hypertension to dimentia (Shenvi et al., 2020). For hypertension treatment, the doctor can recommend lifestyle changes and medications such as;
For Chronic Obstructive Pulmonary Disease treatment (COPD),t he physician will advise Mr.White to:
For a mildly enlarged prostate, he can recommend medication such as:
For treatment of urinary incontinence, the doctor may recommend less invasive treatment options such as:
For dementia, the physician can recommend medications and therapy to slow its symptoms down. For instance;
References
Codling, D., Hood, C., Bassett, P., Smithard, D., & Crawford, M. J. (2021). Delirium screening and mortality in patients with dementia admitted to acute hospitals. Aging & mental health, 25(5), 889–895. https://doi.org/10.1080/13607863.2020.1725804
Hshieh, T. T., Inouye, S. K., & Oh, E. S. (2020). Delirium in the Elderly. Clinics in geriatric medicine, 36(2), 183–199. https://doi.org/10.1016/j.cger.2019.11.001
Janssen, T. L., Alberts, A. R., Hooft, L., Mattace-Raso, F., Mosk, C. A., & van der Laan, L. (2019). Prevention of postoperative delirium in elderly patients planned for elective surgery: systematic review and meta-analysis. Clinical interventions in aging, 14, 1095–1117. https://doi.org/10.2147/CIA.S201323
Shenvi, C., Kennedy, M., Austin, C. A., Wilson, M. P., Gerardi, M., & Schneider, S. (2020). Managing Delirium and Agitation in the Older Emergency Department Patient: The ADEPT Tool. Annals of emergency medicine, 75(2), 136–145. https://doi.org/10.1016/j.annemergmed.2019.07.023
Van-Roessel, S., Keijsers, C., & Romijn, M. (2019). Dementia as a predictor of morbidity and mortality in patients with delirium. Maturitas, 125, 63–69. https://doi.org/10.1016/j.maturitas.2019.03.00
Common Psychiatric Disorders
Mr. White is a 72-year-old man, with a history of hypertension, COPD, and moderate dementia, who presents with 4 days of increased confusion, nighttime restlessness, visual hallucinations, and urinary incontinence. His physical exam is unremarkable except for tachypnea, a mildly enlarged prostate, inattentiveness, and a worsening of his MMSE score from a baseline of 18 to 12 today. Common Psychiatric Disorders Discussion Paper
Mr. White’s presentation is most consistent with an acute delirium (acute change in cognition, perceptual derangement, waxing, and waning consciousness, and inattention).
1. What is the most likely diagnosis to frequently cause acute delirium in patients with dementia?
2. What additional testing should you consider if any?
3. What are treatment options to consider with this patient? Common Psychiatric Disorders Discussion Paper