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

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?
   

   ORDER HERE A PLAGIARISM-FREE PAPER 

Psychiatric Disorders

1. What is the most likely diagnosis to frequently cause acute delirium in patients with dementia?

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

• Attention: here, the practitioner puts the patient through tests such as asking him to name the months of the year backwards (from December to January) to discover his concentration span.
• Awareness: here, the physician enquires if the patient is aware of his surrounding by asking him about his current location and the current year.
• Alertness: within this scenario, he will determine whether the patient can respond appropriately and quickly when asked questions and discover if he is agitated or drowsy.
• Acute change: here, the practitioner will pose questions that would prompt him to discover if the disease symptoms started suddenly and are fluctuating. Common Psychiatric Disorders Discussion Paper

2. What additional testing should you consider if any?

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).

3. What are treatment options to consider with this patient?

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;

• Conducting regular physical exercises
• Consuming healthy diet.
• Limiting caffeine and alcohol intake.
• Taking diuretics to help the kidney eliminate water and salt from the body.

For Chronic Obstructive Pulmonary Disease treatment (COPD),t he physician will advise Mr.White to:

• Use short-acting bronchodilator inhalers (beta-2 agonist and salbutamol) to relax the airways and ease breathing and tachypnea (Van-Roessel et al., 2019).
• Register for a pulmonary rehabilitation program where the physician will train him considering his needs and abilities, recommend a specific diet, and offer psychological and emotional support.

For a mildly enlarged prostate, he can recommend medication such as:

• 5-alpha reductase inhibitors: these include medications such as Proscar and Avodart, which shrinks the prostate and prevent its hormones from overreacting.
• Alpha blockers: these are medications that ease urination by relaxing the prostate bladder neck muscles and fibers (Hshieh et al., 2020). For instance silodosin, tamsulosin, doxazosin, and alfuzosin.

For treatment of urinary incontinence, the doctor may recommend less invasive treatment options such as:

• Pelvic floor muscle exercises that strengthens urination muscles.
• Bladder training where the patient delays urination for about 10 minutes after getting the urge to pee.
• Scheduled toilet trips where the patient urinates after every two to four hours instead of waiting for the urge (Shenvi et al., 2020).
• Fluid and diet management where Mr.White limits consumption of caffeine, alcohol, and acidic foods.

For dementia, the physician can recommend medications and therapy to slow its symptoms down. For instance;

• Cholinesterase inhibitors such as donepezil, rivastigmine, and galantamine to prevent acetylcholinesterase enzyme from breaking Acetylcholine chemical within the brain (Codling et al., 2021).
• Cognitive stimulation therapy where the patient participates in exercises and group activities tailored to improve memory. Common Psychiatric Disorders Discussion Paper

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