Delirium Tremens Delirium Tremens is an emergent situation, that we may regard as the most severe form of alcohol withdrawal syndrome. In most cases, it occurs after long-term heavy use. It may also occur in patients who stop benzodiazepines.  In most cases, it occurs after long-term heavy use of alcohol.  Presentation Psychological and behavioural manifestations Rapidly changing picture Clouding of Consciousness Disorientation Disorganised mental activity Short term memory disturbance Perceptual abnormalities Hallucinations Visual misinterpretations Illusions Cocaine bugs (formication) Behavioural manifestations Agitation Shouting Restlessness Fear Sleeplessness  Physical Manifestations General Physical Dehydration Electrolyte disturbances Autonomic Manifestations Autonomic manifestations of delirium tremens differentiate it from delirium (acute confusional state) that occurs because of organic causes other than substance use and alcohol withdrawal.  Sweating  Fever tachycardia Raised

Mnemonic: Clinical Signs of Anorexia Nervosa BE WICKED Bradycardia  Emaciation  Weak proximal muscles Cold hands and feet Erosion of teeth Dry hand, dependent oedema Swelling of the parotid and submandibular glands, Skin discolouration 

You need about 7-8 hours of sleep per 24-hour cycle. Some people, however, are short sleepers and need much less. With aging, your daily requirement of sleep decreases. If you feel fresh in the day, you are getting adequate amount of sleep.  If you are sleep-deprived, you are prone to a number of adverse physical and mental health outcomes. 

changes in mental health policies that have made dangerousness a relatively more common reason for admission (as non-violent patients are more likely tobe treated in the community) overcrowding lack of sufficiently experienced staff increased use of illegal substances.

Restrictions of diet and activities Increased self-care needs Prospect of complications problems due to complications eg loss of sight or impotence