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Year 2 - BRS > 4.2 - Mental disorders and physical health > Flashcards

4.2 - Mental disorders and physical health Flashcards

1
Q

What is an adjustment reaction?

A

A state of mental distress, interfering with social functioning, that arises from a significant life change or stressful life event

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2
Q

What do the manifestations of an adjustment reaction include? (5)

A
  • depressed mood
  • anxiety
  • worry
  • feeling of inability to cope, plan ahead or continue in the present situation
  • degree of disability in the performance of daily routine
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3
Q

What is post-stroke psychosis?

A

Neuropsychotic symptoms following stroke occur in at least 30% and are a major predictor of poor outcome

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4
Q

Post-stroke psychosis is most commonly seen following what lesions?

A

Most commonly seen in right-sided middle cerebral artery lesions affecting the frontal and temporal regions

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5
Q

What are the most commonly reported psychotic symptom of post-stroke psychosis?

A
  • delusions - most delusions of a persecutory or jealous type (Othello’s syndrome)
  • fixed, false belief not understandable within the person’s sociocultural setting
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6
Q

What are the most common perceptual abnormalities of post-stroke psychosis?

A

Auditory hallucinations followed by visual

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7
Q

How is post-stroke psychosis managed?

A
  • no controlled studies looking at treatment
  • some respond to antipsychotic medication
  • increased risk of stroke with antipsychotics in those with dementia
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8
Q

Why do a lot of people with long term physical conditions also have mental health issues (30%)? (2)

A
  • long term conditions cause disability, inability to work or socialise
  • some medications like high-dose steroids can cause mental health problems
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9
Q

Why do a lot of people with mental health issues also have long term health conditions (46%)? (4)

A
  • chronic stress –> excess cortisol
  • antipsychotics can have long term negative effects on CV system that can increase risk of heart disease and stroke
  • people tend to have bad lifestyle choices e.g. alcohol, smoking
  • some reluctant to access care - pessimism
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10
Q

What are some examples of long term medical conditions that are associated with increased risk of mental illness? (4)

A
  • cardiovascular disease - 3x risk of depression/anxiety
  • MSK disorders - 2x risk of depression
  • diabetes - 2x risk of depression
  • COPD - 10x risk of panic disorder
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11
Q

What is the first job of a psychiatrist?

A

Exclude an organic cause (physical illness) for the patient’s presentation

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12
Q

What mental illnesses can Addison’s disease lead to?

A

Depression, poor concentration, irritability

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13
Q

What mental illnesses can hypercalcaemia lead to?

A

Depression, anxiety

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14
Q

What mental illnesses can hyperthyroidism lead to?

A

Anxiety, mania

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15
Q

What mental illnesses can hypothyroidism lead to?

A

Depression, cognitive impairment

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16
Q

What mental illnesses can Cushing’s syndrome lead to?

A

Depression

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17
Q

What mental illnesses can infections (HPV, syphilis) lead to?

A

Psychosis, dementia

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18
Q

What mental illnesses can SLE lead to?

A

Depression

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19
Q

What mental illnesses can cancer lead to?

A

Depression

20
Q

What mental illnesses can Parkinson’s disease lead to?

A

Depression, anxiety, dementia, psychosis

21
Q

What mental illnesses can phaeochromocytoma lead to?

A

Anxiety

22
Q

What mental illnesses can dementia lead to?

A

Psychosis, aggression/violence, depression, anxiety

23
Q

What mental illnesses can Huntington’s disease lead to?

A

Psychosis, aggression/violence, cognitive impairment, depression, anxiety

24
Q

What psychological adverse effects can dopamine agonists cause?

A

Psychosis

25
Q

What psychological adverse effects can L-dopa cause?

A

Psychosis, delirium, anxiety, depression

26
Q

What psychological adverse effects can steroids (prednisolone) cause?

A

Depression, mania, psychosis, anxiety

27
Q

What psychological adverse effects can isoniazid (TB antibiotic) cause?

A

Mania, psychosis

28
Q

What psychological adverse effects can isoretinoin (roaccutane) cause?

A

Depression

29
Q

What psychological adverse effects can digoxin cause?

A

Depression, psychosis

30
Q

What psychological adverse effects can interferon alpha cause?

A

Depression, mania, psychosis

31
Q

What are people with chronic mental illness at greater risk of?

A

All cause mortality (‘mortality gap’) - patients suffering from severe mental disorders have a reduced life expectancy compared to the general population of up to 10-25 years

32
Q

What multifactorial causes result in the mortality gap in those with chronic mental illnesses? (4)

A
  • medication adverse effects (e.g. weight gain, dyslipidaemia, insulin insensitivity, hypertension, sedation)
  • increased rates of smoking, illicit substance use and alcohol intake
  • poor diet and exercise
  • chaotic lifestyles and low socioeconomic status
33
Q

How can the multifactorial causes of the mortality gap be managed? (5)

A
  • choose medication that minimises impact on physical health e.g. weight gain sparing antidepressants and antipsychotics in those with already increased BMI
  • monitoring of cardiometabolic factors (BMI, HbA1c, lipid profile, blood pressure)
  • smoking cessation
  • dietary advice
  • drug and alcohol support services
34
Q

What is delirium?

A

An acute confusional state and a neuropsychiatric manifestation of physical illness/injury/interventions - can be considered ‘acute brain failure’ (vs ‘chronic brain failure’ in dementia)

35
Q

What can delirium be broadly classified as? (3)

A
  • hyperactive - agitation, hallucinations, inappropriate behaviour
  • hypoactive - lethargy, reduced concentration, reduced alertness, reduced oral intake
  • mixed - combination of above
36
Q

What is the epidemiology of delirium?

A
  • affects 50% of those in hospital aged >65
  • complicates 80% of ITU admissions
  • may affect 14% of those >85 in community
  • leads to increased mortality and delays in discharge
37
Q

What are some risk factors for delirium? (5)

A
  • advancing age
  • cognitive impairment (e.g. dementia), sensory impairment
  • poor nutrition
  • polypharmacy/alcohol misuse
  • frailty
38
Q

What are some common causes/precipitating factors of delirium?

A
  • physical illness/injury:
  • infection
  • constipation
  • urinary retention
  • electrolyte disturbance
  • pain
  • acute vascular events
  • dehydration
  • pretty much anything can cause delirium in those sufficiently at risk
39
Q

What is a mnemonic for the causes of delirium?

A
  • P - pain
  • I - infection
  • N - nutrition
  • C - constipation
  • H - hydration
  • M - medication
  • E - environment / electrolyte disturbance
40
Q

What is the pathophysiology of delirium?

A

Poorly understood and likely multifactorial

  • (a critical illness leads to increased cortisol levels and cerebral hypoxia (older adults predisposed) which leads to reduced ACh synthesis and dysfunctions of hippocampal and neocortical areas - increase dopamine 500x and adrenergic output)
  • (likely several neurobiological processes that contribute to delirium pathogenesis including neuroinflammation, brain vascular dysfunction, altered brain metabolism, neurotransmitter imbalance and impaired neuronal network connectivity)
41
Q

How is delirium managed? (6)

A
  • anticipate and address any modifiable risk factors (e.g. reduce polypharmacy, visual and hearing aids)
  • optimise treatments of underlying co-morbidities
  • treat any underlying cause (e.g. UTI, constipation, physical injury, electrolyte disturbance, dehydration)
  • re-orientation strategies (familiar environments, clocks, remind of name and location)
  • normalise sleep-wake cycle (encourage uninterrupted sleep, use appropriate lighting, discourage daytime napping)
  • maintain safe mobility to avoid falls
42
Q

How is challenging behaviour in delirium managed? (4)

A
  • address underlying unmet needs (thirst, need for toilet, discomfort/pain)
  • safe and low stimulation environments
  • verbal and non-verbal de-escalation techniques
  • in extremis - short term pharmacological interventions (e.g. low dose Haloperidol [0.5mg] for <7 days)
43
Q

How prevalent is stigma around mental health?

A
  • 3 in 4 people with mental illness experience stigma
  • rates are higher in those from BAME groups
  • cultural variation in the perception of mental illness
44
Q

What does stigma lead to? (3)

A
  • barrier to accessing all aspects of care
  • can be a risk factor for people experiencing abuse, rejection and isolation
  • contributes to difficulties in employment
45
Q

What factors affect the diagnosis of physical disorders in people with mental illness? (3)

A
  • illness behaviour (e.g. poor insight, mistrust of others, chaotic lifestyle)
  • diagnostic overshadowing (misattribution of physical symptoms to psychiatric symptoms)
  • lack of resources/access to services (low socioeconomic status is a risk factor for the development of mental disorders)

Year 2 - BRS (84 decks)

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