1b// Psychiatry and Physical Health Flashcards

Question

Can mental illness present with physical symptoms?

Answer 1

ventricles look larger (aka atrophy of brain matter) temporo-parietal cortical atrophy mesial temporal lobe atrophy mild small vessel disease

Answer 2

An acute confusional state and a neuropsychiatric manifestation of physical illness/injury/interventions o Can be considered as “acute brain failure” compared to “chronic brain failure” (dementia) “Delirium is characterized by a disturbance of attention, orientation, and awareness that develops within a short period of time, typically presenting as significant confusion or global neurocognitive impairment, with transient symptoms that may fluctuate depending on the underlying causal condition or etiology. Delirium often includes disturbance of behaviour and emotion, and may include impairment in multiple cognitive domains. A disturbance of the sleep-wake cycle, including reduced arousal of acute onset or total sleep loss with reversal of the sleep- wake cycle, may also be present. Delirium may be caused by the direct physiological effects of a medical condition not classified under mental, behavioural or neurodevelopmental disorders, by the direct physiological effects of a substance or medication, including withdrawal, or by multiple or unknown etiological factors”

Answer 3

o Hyperactive – Agitation, hallucinations, inappropriate behaviour o Hypoactive – Lethargy, reduced concentration, reduced alertness, reduced oral intake o Mixed – A combination of the above

Answer 4

o Affects 50% of those in hospital aged >65 o Complicates 80% of ITU admissions o May affect 14% of those >85 in the community o Leads to increased mortality and delays in discharge

Answer 5

o Advancing age o Cognitive impairment (e.g. dementia), sensory impairment o Poor nutrition o Polypharmacy/alcohol misuse o Frailty

Answer 6

Common causes/ precipitating factors - Physical illness or injury (e.g. infection, constipation, urinary retention, electrolyte disturbance, pain, acute vascular events, dehydration) o i.e. pretty much anything can cause delirium in those sufficiently at risk!

Answer 7

Pathophysiology - Is poorly understood and likely multi-factorial A critical illness leads to increased cortisol levels and cerebral hypoxia (older adults predisposed) which leads to ↓acetylcholine synthesis and dysfunctions of hippocampal and neocortical areas (↑500 times dopamine and ↑adrenergic output) (Maldonado, 2008) likely several neurobiological processes that contribute to delirium pathogenesis, including neuroinflammation, brain vascular dysfunction, altered brain metabolism, neurotransmitter imbalance and impaired neuronal network connectivity (Wilson et al, 2020)

Answer 8

Anticipate and address any modifiable risk factors (e.g. reducing polypharmacy, visual and hearing aids) Optimise treatment of underlying co-morbidities Treat any underlying cause (e.g. UTI, constipation, physical injury, electrolyte disturbance, dehydration) Re-orientation strategies (familiar environments, use of clocks, reminding of name and current location) Normalise sleep-wake cycle (encourage uninterrupted sleep, use of appropriate lighting, discourage daytime napping) Maintain safe mobility to avoid falls

Answer 9

o Address underlying unmet needs (thirst, need for toilet, discomfort/pain) o Safe and low stimulation environments o Verbal and non-verbal de-escalation techniques o In extremis – Short term pharmacological interventions (e.g. low dose Haloperidol [0.5mg] for <7 days)

Answer 10

3 in 4 people with mental illness experience stigma o Rates are higher in those from Black, Asian and ethnic minority groups o Cultural variation in the perception of mental illness In 1998 RCPsych started a 5 year campaign to reduce stigma called “Changing Minds” Stigma is a barrier to accessing all aspects of care Stigma can also be a risk factor for people experiencing abuse, rejection and isolation Stigma contributes to difficulties in employment

Answer 11

o Illness behaviour (e.g. poor insight, mistrust of others, chaotic lifestyle) o Diagnostic overshadowing (misattribution of physical symptoms to psychiatric symptoms) o Lack of resources/lack of access to services (low socio-economic status is a risk factor for the development of mental disorders)

Answer 12

State of SUBJECTIVE DISTRESS and EMOTIONAL DISTURBANCE, usually interfering with social functioning and performance, arising in the period of adaptation to a significant life change or a stressful life event... the manifestations vary and include depressed mood, anxiety or worry (or mixture of these), a feeling of inability to cope, plan ahead, or continue in the present situation, as well as some degree of disability in the performance of daily routine.

Answer 13

a disorder in which persistent or recurrent delusions dominate the clinical picture. the delusions may be accompanied by hallucinations. Some features suggestive of schizophrenia, such as bizarre hallucinations or thought disorder, may be present.

Answer 14

inability to control emotions due to right hemisphere brain damage - common complication of stroke

Answer 15

people with chronic mental illness are at greater risk of physical illness - diet and exercise - smoking, alcohol and drugs - medication people with chronic mental illness die 20 years younger than the general populatoin

Answer 16

illness behaviour diagnostic overshadowing stigma lack of resources

Answer 17

Diagnostic overshadowing, which is a judgment bias where health care professionals mistakenly attribute clinical manifestations of physical illness (eg, pain, tachycardia, hypertension) to manifestations associated with a pre-existing mental illness.

Answer 18

organic cerebral syndrome characterized by concurrent disturbances of consciousness and attention, perception, thinking, memory, psychomotor behaviour, emotion, and the sleep-wake schedule. The duration is variable and the degree of severity ranges from mild to severe.

Answer 19

delirium is a psychiatric manifestation of a physical illness - can be hypoactive or hyperactive delays discharge and increases mortality

Answer 20

also known as acute confusional state

Answer 21

Infection (urine, pneumonia, cellulitis, wound etc.) Change in environment (ITU, HDU, ward) Medication (opiates, anticholinergics, steroids) Alcohol withdrawal Surgery Pain Liver/ renal impairment Hyponatraemia Hypoxia Stroke Encephalitis Constipation Urine retention Dehydration

Answer 22

advanced age dementia (often undetected) impaired activities of daily living immobility sensory impairment urinary catheterization malnutrition alcohol depression

Answer 23

Anticipate Modify risk factors if possible Early diagnosis Treat the causes Good nursing - single room, well lit, familiar staff/ family Medication Wait!

Answer 24

Stigma is a barrier to accessing care Stigma leads to abuse, rejection and isolation

1b// Psychiatry and Physical Health Flashcards

(53 cards)