Psych Vivas · Old age psychiatry — delirium and acute cognitive syndromes
Delirium in older adults — structured clinical viva
Fellowship viva covering CAM, hypoactive/mixed presentations, HELP-style care, avoid benzos, cautious low-dose antipsychotics with trial caveats, capacity, and Witlox/BRAIN-ICU prognosis messages.
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Target exams
FRANZCPMRCPsychABPNMD-DNB
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 interpretationShowHide
References8ShowHide
- [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