Delirium and functional disorders flashcards
8 high-yield MRCP Part 1 cards from the Intellect Medicos Psychiatry course. Try to answer each question before you open it — then study them properly with spaced repetition, which brings each card back just before you would forget it.
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Which features best distinguish delirium from dementia?
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Acute onset over hours to days, a fluctuating course through the day, and impaired attention and awareness.
Why? Dementia is gradual and progressive with attention relatively preserved early; delirium is acute and fluctuating.
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What is the first-line management of delirium?
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Find and treat the underlying cause, plus non-drug measures (reorientation, glasses and hearing aids, sleep, hydration, avoiding ward moves).
Why? Delirium is a sign of an acute illness or drug effect (infection, drugs, metabolic disturbance, urinary retention, constipation, pain).
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A delirious patient is distressed and a risk to others despite de-escalation. Which drug is usually used short term?
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Low-dose haloperidol, usually for 1 week or less.
Why? NICE CG103 allows short-term haloperidol when non-drug measures fail and the patient is distressed or at risk.
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A 28-year-old woman lost her voice after a stressful family event. She can only whisper, but her cough is normal. What is the first-line investigation?
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Laryngoscopy.
Why? It excludes organic causes such as laryngeal cancer or recurrent laryngeal nerve palsy. In functional aphonia the vocal cords look and move normally.
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Which short bedside tool does NICE recommend for assessing suspected delirium on general wards?
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The 4AT.
Why? It tests alertness, orientation (AMT4), attention (months backwards) and acute change or fluctuating course, and needs no special training. In critical care or recovery, NICE recommends CAM-ICU or ICDSC instead.
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Deliberately producing symptoms for an internal (primary) gain such as attention or sympathy is ______; doing so for an external (secondary) gain such as money or time off work is malingering.
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factitious disorder (Munchausen syndrome)
Why? In somatic symptom and conversion disorders the symptoms are not produced consciously.
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Deliberately producing symptoms for an internal (primary) gain such as attention or sympathy is factitious disorder (Munchausen syndrome); doing so for an external (secondary) gain such as money or time off work is ______.
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malingering
Why? In somatic symptom and conversion disorders the symptoms are not produced consciously.
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The day before her final exams, a 20-year-old suddenly cannot move her legs. Reflexes, tone and imaging are normal, and Hoover's sign is positive. She is not consciously faking. What is the most likely diagnosis?
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Conversion disorder (functional neurological disorder).
Why? Psychological stress is converted into motor or sensory symptoms that are not intentionally produced. Exclude organic disease, then explain the diagnosis positively and refer for physiotherapy and psychological therapy.