Prompt

You are the old-age psychiatry registrar. A 79-year-old man with mild cognitive impairment develops fluctuating confusion and inattention on day three after hip fracture surgery. Nursing staff request 'something to settle him' and suggest midazolam. Discuss diagnosis (including CAM), motor subtypes, cause map, multicomponent prevention and treatment, why benzodiazepines are usually avoided, when low-dose antipsychotics might be used carefully, capacity, and prognosis.

Interpretation

Reveal interpretation

Working diagnosis: postoperative delirium in a vulnerable older adult with MCI (high DSD risk). Confirm with CAM/3D-CAM/4AT and collateral. Midazolam for non-withdrawal "settling" is the wrong reflex — treat causes and deliver multicomponent non-drug care first.[1][3][4]

Psychiatry Fellowship Pro

You have read the opening of this viva. The complete unit — every section and its primary-source references — is part of the Psychiatry Fellowship fellowship atlas.

References8Show ledger

[1]Inouye SK, van Dyck CH, Alessi CA, et al. Clarifying confusion: the confusion assessment method. A new method for detection of delirium Ann Intern Med, 1990.PMID 2240918
[2]Inouye SK, Bogardus ST Jr, Charpentier PA, et al. A multicomponent intervention to prevent delirium in hospitalized older patients N Engl J Med, 1999.PMID 10053175
[3]Marcantonio ER Delirium in Hospitalized Older Adults N Engl J Med, 2017.PMID 29020579
[4]Oh ES, Fong TG, Hshieh TT, et al. Delirium in Older Persons: Advances in Diagnosis and Treatment JAMA, 2017.PMID 28973626
[5]Girard TD, Exline MC, Carson SS, et al. Haloperidol and Ziprasidone for Treatment of Delirium in Critical Illness N Engl J Med, 2018.PMID 30346242
[6]Andersen-Ranberg NC, Poulsen LM, Perner A, et al. Haloperidol for the Treatment of Delirium in ICU Patients N Engl J Med, 2022.PMID 36286254
[7]Witlox J, Eurelings LS, de Jonghe JF, et al. Delirium in elderly patients and the risk of postdischarge mortality, institutionalization, and dementia: a meta-analysis JAMA, 2010.PMID 20664045
[8]Pandharipande PP, Girard TD, Jackson JC, et al. Long-term cognitive impairment after critical illness N Engl J Med, 2013.PMID 24088092

Interpretation

Reveal interpretation

Psychiatry Fellowship Pro

You have read the opening of this viva. The complete unit — every section and its primary-source references — is part of the Psychiatry Fellowship fellowship atlas.

References8Show ledger

[1]Inouye SK, van Dyck CH, Alessi CA, et al. Clarifying confusion: the confusion assessment method. A new method for detection of delirium Ann Intern Med, 1990.PMID 2240918
[2]Inouye SK, Bogardus ST Jr, Charpentier PA, et al. A multicomponent intervention to prevent delirium in hospitalized older patients N Engl J Med, 1999.PMID 10053175
[3]Marcantonio ER Delirium in Hospitalized Older Adults N Engl J Med, 2017.PMID 29020579
[4]Oh ES, Fong TG, Hshieh TT, et al. Delirium in Older Persons: Advances in Diagnosis and Treatment JAMA, 2017.PMID 28973626
[5]Girard TD, Exline MC, Carson SS, et al. Haloperidol and Ziprasidone for Treatment of Delirium in Critical Illness N Engl J Med, 2018.PMID 30346242
[6]Andersen-Ranberg NC, Poulsen LM, Perner A, et al. Haloperidol for the Treatment of Delirium in ICU Patients N Engl J Med, 2022.PMID 36286254
[7]Witlox J, Eurelings LS, de Jonghe JF, et al. Delirium in elderly patients and the risk of postdischarge mortality, institutionalization, and dementia: a meta-analysis JAMA, 2010.PMID 20664045
[8]Pandharipande PP, Girard TD, Jackson JC, et al. Long-term cognitive impairment after critical illness N Engl J Med, 2013.PMID 24088092

Delirium in older adults — structured clinical viva

Interpretation

Delirium in older adults — structured clinical viva

Interpretation