Well-formed hallucinations, vivid dreams, fluctuating cognition, sleep disorder w/ periods of daytime sleeping, frequent falls, deficits in visuospatial ability & REM sleep disorder. Dementia can be a complication of chronic alcohol abuse, reinforcing the need fo r a complete history of substance abuse. Metabolic abnormalities, such as hyponatremia or abnormal calcium levels, & other infections, such as AIDS, can also cause dementia. Delirium is an acute change in mental status that is characterized by fluctuations in levels of cons ciousness. The treatment for delirium is treatment of the condition that precipitated it. o Delirium is often reversible if the underlying cause can be found & aggressively managed. o Pts w/ delirium have significantly longer hospital stays & increased mortality rates. o Case 33 – Obesity: Metabolic syndrome: a state of insulin resistance characterized by abdominal obesity, dyslipidemia, elevated BP, & impaired fasting glucose. Obesity: an excessive amt of body f at, which increases the risk of medical illness & premature death. Satiation: level of fullness during a meal. Satiety: level of hunger after a meal. Recent data show that 33.3% of adult men, 35.3% of adult women, & 16% of 2- to 19-year-olds were obese. BMI is not an accurate measure of overweight/obesity in patients w/ heart failure, pregnant women, body builders, & certain ethnic groups. Obesity is caused by ingesting more energy than is expended over a period of time. Energy balance is affected by both genetic & environmental factors. It’s estimated that genetic background can explain 40% or more of the variance in body mass in humans. o An increase in energy consumption w/ a decrease in physical activity is thought to be the main contributor to o the current obesity epidemic. Treatment of obesity should begin in patients w/ a BMI greater than 25 or who have visceral obesity, documented by increased waist circumference or a waist-to-hip ratio greater than 0.9 in men & greater than 0.85 in women. Developing a treatment plan for obesity is complex & should u se a combination of dietary restrictions, o increased physical activity, & behavior therapy as a gold standard. A calorie deficit of 500 to 1000 cal/d produces a weight loss of 1 to 2 lb/week. o Physical activity alone is not an effective method for achieving weight loss. Although increasing physical o activity is not effective for initial weight loss, physical activity is very important for long -term weight management. The purpose of behavior modification therapy is to help patients identify & modify eating & physical activity habits that contribute to obesity. Anorexieant medications increase satiation, satiety, or both, by affecting the monoamine system in the hypothalamus. Increasing satiation results in a reduction in the amount of food eaten, whereas increasing satiety reduces the frequency of eating. Only orlistat & sibutramine are indicated for long-term treatment of obesity. Patients w/ a BMI greater than 40, or greater than 35 w/ comorbid conditions, are potential candidates for surgical treatment of obesity. Metabolic syndrome: Abdominal obesity, defined as a waist circumference in men greater than 40 in & in women greater than 35 o in. Serum TGL greater than or equal to 150 mg/dL. o Serum high-density lipoprotein cholesterol less than 40 mg/dL in m en & less than 50 mg/dL in women. o BP greater than or equal to 130/85 mm Hg. o Fasting plasma glucose greater than or equal to 110 mg/dL. o Case 34 – Migraine Headache: Characteristic classic migraine w/out aura symptoms are unilateral, throbbing in nature, & have been progressively worse. Migraine headaches are the most common headaches of vascular origin. They typically cause recurrent o episodes of headache, nausea, & vomiting. “Red Flag” symptoms & signs in the eval of headache: Sudden-onset headache. o Headaches increasing in severity & frequency. o Headache beginning after age of 50 yrs. o New-onset headache in pt w/ risk factors for HIV infection or cancer. o Headache w/ signs of systemic illness (fever, stiff neck, rash). o Focal neurologic signs or symptoms of disease (other than typical aura). o Papilledema o Headache subsequent to head trauma. o o
