post- marianne

 Respond in a positive way to your  colleagues by comparing the differential diagnostic features of the  disorder you were assigned to the diagnostic features of the disorder  your colleagues were assigned. 

NOTE: Bellow is attached the document with my assigned disorder 

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Delirium  is an acute intermittent neuropsychiatric condition generally  reversible but serious condition that occurs in all age groups but high  risk in the elderly(Gabbard, 2014).  It ultimately represents the decompensation of brain function as a  result of one or more pathophysiological processes(Fong, 2009). Delirium  is linked with a variety of negative effects, leading to extended  hospital stay, institutional care demands, poor functioning and high  medical costs(Fong, 2009).Due to these negative consequences it is essential to prevent, detect and treat delirium as early as possible.

Diagnostic criteria

Accordint to the DSM-5, diagnostic criteria for delirium is :

A.  A disturbance in attention (i.e., reduced ability to direct, focus,  sustain, and shift attention) and awareness (reduced orientation to the  environment) (American Psychiatric Association, 2013).

B.The  disturbance develops over a short period of time (usually hours to a  few days), represents a change from baseline attention and awareness,  and tends to fluctuate in severity during the course of a day(American  Psychiatric Association, 2013).

C.An  additional disturbance in cognition (e.g., memory deficit,  disorientation, language, visuospatial ability, or perception) (American  Psychiatric Association, 2013).

D.The  disturbances in Criteria A and C are not better explained by another  preexisting, established, or evolving neurocognitive disorder and do not  occur in the context of a severely reduced level of arousal, such as  coma(American Psychiatric Association, 2013).

E.There  is evidence from the history, physical examination, or laboratory  findings that the disturbance is a direct physiological consequence of  another medical condition, substance intoxication or withdrawal( due to a  drug of abuse or to a medication), or exposure to a toxin, or is due to  multiple etiologies(American Psychiatric Association, 2013).

 Psychotherapy and Psychopharmacologic Treatment 

Delirium  is a medical emergency that involves proper diagnosis, recognition of  the cause and management of symptoms.The first-line treatment is to  identify and address pre- disposing factors, provide supportive care,  and manage symptoms through behavioral strategies(Fong, 2009). Treatment  is geared toward symptom management and patient centered.Medications  are used to control agitation and reverse hyperactive delirium (Fong,  2009).Medication treatment includes antipsychotics such as haloperidol  and chlorpromazine.The goals of these pharmacological agents is to  reduce agitation and address other symptoms associated with hyperactive  deliria (Gabbard, 2014).Non-pharmacological  treatment of delirium stresses the removal or reduction of medical,  sensory and environmental factors that can lead to delirium,such as  modifying sensory deficits in order to improve engagement with the  environment, particularly when coupled with sufficient intellectual  stimulation during wake-up hours (Gabbard, 2014).Lastly,  immoboizing devices can be used but should be reserved when harm to  self and others is immenent, and should be short and behaviroal targeted(Gabbard, 2014).

Benefits and Risks of Therapy

When choosing any drug, attention should always be given to the possible advantages,

dangers  and pressures of each medicine, as well as to the patient and family  care priorities (Grover, 2018).The use of antipsychotics have many  adverse effects that include sedation, wiegth gain, changes in appetite,  cardiac effects(such as QT prolongation), neaurological effects, falls  and long term need for use that is inappropriate but in many cases it is  the best course of action.According to Fong (2009), studies some  beneficial roles of antipsychotics such as lowering severity of delirum,  reducing harm to self and others are the main reasons why these agents  are used.However, Grover (2018), emphasizes that antipsychotics for the  treatment of delirium in adult inpatients did not improve patient  outcomes, with little evidence of neurologic harms but a tendency for  more frequent potentially harmful cardiac effects.


American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders   (5th ed.). Washington, DC: Author.

Fong, T. G., Tulebaev, S. R., & Inouye, S. K. (2009). Delirium in elderly adults: diagnosis,   prevention and treatment. Nature reviews. Neurology, 5(4), 210–220.   doi:10.1038/nrneurol.2009.24 Mayo Clinic. 2018. Delirium. 

Gabbard, G.O.(2014). Gabbard’s treatment of psychiatric disorders(5th ed.).Washington, DC:   American Psychiatric Publications

Grover, S., & Avasthi, A. (2018). Clinical Practice Guidelines for Management of Delirium in   Elderly. Indian journal of psychiatry, 60(Suppl 3), S329–S340.

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