MEDICAL

AN 83 YEAR OLD WOMAN HAS VISUAL HALLUCINATIONS AND IS CONFUSED FOR 4 HOURS. SHE IS ON THE MEDICAL INPATIENT WARD AND IS BEING TREATED FOR PNEUMONIA. SHE IS RESTLESS AND VERBALLY ABUSIVE TOWARDS THE STAFF WHO SHE BELIEVES ARE TRYING TO POISON HER. SHE HAS NO PREVIOUS PSYCHIATRIC HISTORY. WHICH IS THE MOST LIKELY DIAGNOSIS?

  • A. Delirium ✓
  • B. Delusional disorder
  • C. Charles Bonnet syndrome
  • D. Parkinsons disease dementia
  • E. Psychotic depression

 

The most likely diagnosis for the 83-year-old woman is delirium. The symptoms described, such as visual hallucinations, confusion, restlessness, and abusive behavior towards the staff, are all indicative of this condition. Delirium is a common disturbance in attention and awareness, often fluctuating in severity, and it can be caused by various medical conditions, including pneumonia.

Delirium is a serious disturbance in mental abilities that results in confused thinking and reduced awareness of the environment. The condition can come on suddenly and is typically temporary. It can cause people to be disoriented, have trouble with memory, move in an agitated manner, and experience changes in behavior, sleep patterns, and emotions. Delirium can also lead to hallucinations – seeing or hearing things that aren’t there.

In this case, the patient is an 83-year-old woman with pneumonia who is experiencing visual hallucinations and confusion. Several risk factors increase the likelihood of delirium:

  1. Age: Older adults are more susceptible to delirium due to age-related changes in brain function.
  2. Severe illness: The patient’s pneumonia increases her risk of developing delirium due to the physiological stress caused by the infection.
  3. Sensory impairment: Visual hallucinations may be partly explained by underlying eye problems or sensory impairment.
  4. Medication: Certain medications can contribute to delirium. However, since the patient does not have a previous psychiatric history, this risk factor might be less relevant in this case.

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