This Week's Content Discussed Common Psychiatric Disorders

This Weeks Content Discussed Common Psychiatric Disorders In The Adul

This week's content discussed common psychiatric disorders in the adult and older adult client. It also covered the importance of identifying secondary diagnoses that may be masked by primary psychiatric conditions. In particular, the focus was on the presentation, diagnosis, and management of psychiatric disorders such as delirium in elderly patients, especially those with comorbidities like dementia. The case study of Mr. White, a 72-year-old man with hypertension, COPD, dementia, and recent worsening cognition, was used to illustrate key concepts related to delirium, its common causes, diagnostic approaches, and treatment options.

Paper For Above instruction

Delirium is an acute, fluctuating disturbance of consciousness, attention, cognition, and perception, often caused by underlying medical conditions in elderly patients. In individuals with dementia, delirium can be superimposed, complicating diagnosis and management. One of the most common causes of delirium in dementia patients is infections, particularly urinary tract infections (UTIs). Identifying the primary etiology is critical because delirium can significantly impact morbidity, mortality, and healthcare costs, especially in older adults with pre-existing cognitive impairment.

In the case of Mr. White, a 72-year-old man with moderate dementia and multiple comorbidities, his sudden change in mental status, increased confusion, hallucinations, and incontinence are highly suggestive of an acute delirium. The differential diagnosis should prioritize infections, metabolic disturbances, medication effects, and other medical issues. As per current literature, UTIs are a frequent precipitant of delirium in elderly adults with dementia, accounting for up to 30-50% of cases. Factors such as prostatic hypertrophy, diabetes, and urinary retention further predispose male patients like Mr. White to UTIs.

Additional testing should include urinalysis and urine culture to confirm the presence of infection, especially since bacteria may be asymptomatic in this population, and atypical presentations are common. Blood work to evaluate metabolic and electrolytic disturbances, complete blood count, and assessments of renal function can also help identify contributing factors. Imaging or neurological assessments may be warranted if no clear infectious source is identified or if the patient’s mental status does not improve with initial treatment.

Management of delirium in elderly patients with dementia involves treating the underlying cause—in this case, a suspected UTI. Antibiotic therapy tailored to the identified pathogen, such as fluoroquinolones like ciprofloxacin, is commonly used owing to its good prostatic and urinary tract penetration in males. Hospitalization is often necessary, particularly if the patient exhibits severe confusion, inability to maintain hydration or nutrition, or if the cognitive decline suggests progression of dementia. The use of antipsychotic medications is generally reserved for cases where agitation or psychosis pose a safety risk and should be used cautiously due to potential adverse effects.

Preventive measures include ensuring adequate hydration, regular toileting, and careful medication management to minimize iatrogenic contributors to delirium. Family education on early recognition of delirium symptoms can also facilitate prompt medical evaluation. In Mr. White’s case, given his cognitive decline from MMSE 18 to 12, hospital admission for IV antibiotics and close monitoring are appropriate. Addressing erectile or prostatic issues in the long term can reduce recurrence risk.

In conclusion, recognizing and managing delirium in older adults with dementia necessitates a comprehensive approach targeting potential infectious, metabolic, and medication-related causes. Early diagnosis and intervention not only improve patient outcomes but also reduce the likelihood of long-term cognitive decline and institutionalization. Clinicians should prioritize thorough assessment and individualized treatment strategies to optimize care for this vulnerable population.

References

• Krinitski, D., Kasina, R., Kläppel, S., & Lenouvel, E. (2021). Associations of delirium with urinary tract infections and asymptomatic bacteriuria in adults aged 65 and older: A systematic review and meta-analysis. Journal of the American Geriatrics Society, 69(11), 3312–3323.
• Mayne, S., Bowden, A., Sundvall, P., & Gunnarsson, R. (2019). The scientific evidence for a potential link between confusion and urinary tract infection in the elderly is still confusing - a systematic literature review. BMC Geriatrics, 19(32).
• Rodriguez-Mañas, L. (2020). Urinary tract infections in the elderly: a review of disease characteristics and current treatment options. Drugs in Context, 9.
• Smithson, A., Ramos, J., Nino, E., Culla, A., Pertierra, U., Friscia, M., & Batisda, M. T. (2019). Characteristics of febrile urinary tract infections in older male adults. BMC Geriatrics, 19, 334.
• Inouye, S. K., Westendorp, R. G., & Saczynski, J. S. (2014). Delirium in elderly people. The Lancet, 383(9920), 911-922.
• Inouye, S. K. (2006). Delirium in older persons. New England Journal of Medicine, 354(11), 1157-1165.
• Fick, D. M., et al. (2015). AGS position statement: delirium: diagnosis, prevention, and management. Journal of the American Geriatrics Society, 63(1), 142-150.
• Siddiqi, N., et al. (2016). Interventions for preventing delirium in hospitalized patients. Cochrane Database of Systematic Reviews, (3).
• Han, J. H., et al. (2019). Delirium risk factors, incidence, and outcomes in elderly medical inpatients. Clinical Interventions in Aging, 14, 1501-1508.
• Inouye, S. K., et al. (2014). Geriatric syndromes: clinical, research, and policy challenges. American Journal of Medicine, 127(12), 1090-1097.