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liaison psychiatry Flashcards

1
Q

what is liaison psychiatry

A

link between general medicine and psychiatry in hospital setting

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2
Q

what is delirium?

A

an acute confusional state

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3
Q

what disturbances are seen in delirium?

A
  1. consciousness and attention
  2. perception
  3. thinking
  4. memory
  5. psychomotor behaviour
  6. emotion
  7. sleep-wake cycle
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4
Q

duration of delirium

A

variable

variable severity

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5
Q

onset of delirium

A

acute, sudden

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6
Q

what is the core feature of delirium?

A

inattention

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7
Q

delirium and future cognitive decline?

A

increases risk

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8
Q

how does delirium affect outcomes?

A

worsens and increases mortality rates

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9
Q

RFs for delirium?

A
  1. elderly
  2. previous
  3. dementia
  4. pain
  5. constipation
  6. infection
  7. electrolytes
  8. medication
  9. sensory impairment
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10
Q

causes of delirium?

A

I WATCH DEATH

Infection
Withdrawal
Acute metabolic syndrome
Trauma
CNS pathology
Hypoxia
Deficiency - thiamine, anoxia
Endocrine - hypo/erthyroid, cushings, addisons
Acute vascular/MI
Toxins/drugs - CO, steroids, opiates, digoxin
Heavy metals - lead, mercury
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11
Q

workup for delirium

A
  1. med = psych hx
  2. collateral hx
  3. MMSE
  4. pex
  5. ix
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12
Q

ix for delirium?

A

Basically everything
don’t forget:

TFTs
B12
folate
VDRL
septic screen
drug screen
EEG
LP
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13
Q

assessment scales for delirium?

A
  1. MMSE
  2. AMTS
  3. AMT-4
  4. CAM

attention assessments

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14
Q

attention assessments for delirium

A

MBT - months of the year backwards
days of the week backwards
count from 20 to 1
SAVEAHAART - >2 errors = fail, squeeze hand at A

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15
Q

mangt delirium?

A

tx UC

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16
Q

environmental mangt delirium?

A
  1. psychoeducation
  2. family involvement
  3. reorientate frequently
  4. environmental cues - clock/calendar
  5. lighting for time of day
  6. give glasses, hearing aid
  7. mobilise and ADLs
  8. 1:1 nursing
  9. stop unnecessary meds
  10. treat pain, constipation, dehydration etc
  11. meds - not 1st line
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17
Q

meds in delirium?

A

antipsychotics may reduce duration

not 1st line

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18
Q

indications for meds in delirium?

A
  1. patient distress
  2. risk harm to patient/others
  3. v disturbed sleep
  4. significant behavioural prob
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19
Q

what is a conversion disorder?

A

thoughts or memories that are unacceptable are repressed and converted into physical symptoms

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20
Q

what is a dissociative disorder?

A

condition involving breakdown of memory, awareness, identity or perception - defense mechanism that is pathological and involuntary

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21
Q

examples of dissociative disorder?

A
  1. dissociative amnesia
  2. dissociative fugue
  3. trance and possession disorder
  4. dissociative motor disorders - paralysis, aphonia
  5. dissociative convulsions
  6. dissociative anaesthesia and sensory loss
  7. other eg ganser syndrome
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22
Q

DSM vs ICD 10 dissociative and conversion

A

DSM - conversion = motor or sensory deficit, diss = function of consciousess disturbance

ICD10 - use both synonymously, prefer diss.

23
Q

cause of DDs?

A
  1. psychogenic

2. traumatic events

24
Q

what do sufferers hope to gain from DDs?

A

nothing

25
Q

onset and offset of DDs?

A

sudden

26
Q

how long do DDs last?

A

weeks - months max

27
Q

features of dissociative convulsions?

A
  1. non epileptic but commonly in those with epilepsy
  2. usually an audience
  3. no injury when fall
  4. don’t bite tongue or incontinent
  5. general shaking, not tonic clonic
  6. no post ictal confusion or raised prolactin
  7. usually a stressor
28
Q

how are DDs diagnosed?

A
  1. clinically inconsistent signs
  2. exclude organic dz
  3. demonstrate function thought to be absent
  4. convincing psych explanation
29
Q

tx DDs?

A
  1. supportive psychotherapy
  2. explain initially organic sx but now due to maladaptive response
  3. physio
  4. tx comorbid psych prob
30
Q

px DDs?

A

if acute conversion - good esp if obvious cause

poor outcomes in long lasting and established sx

31
Q

what are the kinds of medically unexplained symptoms?

A
  1. somatoform disorders

2. simulated disorders

32
Q

how common are MUS?

A

1/3 of symptoms in PC

50% in secondary care

33
Q

what are the somatoform disorders (ICD10)

A
  1. somatisation
  2. hypochondriacal
  3. somatoform pain disorder
34
Q

what is somatisation

A
  1. experience bodily symptoms with no physical cause and assumed psych cause
35
Q

what is hypochondriasis?

A
  1. believing one has an illness DESPITE evidence to contrary

- eg an overvalued idea that goes to delusional intensity

36
Q

so what’s the diff between hypochondriasis and somatisation?

A

preoccupation with symptoms vs preoccupied with disorder

37
Q

other features of somatoform disorders?

A

impaired functioning

history of stressful life events or psych trauma

38
Q

somatisation affects ___________ organ system

A

multiple

39
Q

when does somatisation present?

A
40
Q

how long do symptoms have to last in somatisation?

A

2 years

41
Q

prevalence of somatisation disorder

A

0.13%

42
Q

gender in somatisation?

A

F>M

43
Q

course of somatisation?

A

chronic relapsing

44
Q

management principles of somatisation disorder?

A
  1. must trust doc
  2. consistency
  3. minimise investigations
  4. focus on new symptoms
  5. be clear about findings
  6. psych - meds for comorbid and CT
  7. focus on function not symptoms
45
Q

how long does hypochondriasis have to last?

A

at least 6 months

46
Q

is hypochondriasis delusional

A

NO

47
Q

prevalence of hypochondriasis?

A

0.8-5%

48
Q

course of hypochondriasis

A

chronic relapsing

comorbidities common

49
Q

cause hypochondriasis

A

unknown

50
Q

mx of hypochondriasis?

A

SSRI high dose

CBT

51
Q

what are the consciously simulated disorders?

A

malingering

factitious - munchausens +/- by proxy

52
Q

Malingering what is it?

A

patient conscious of gain and producing symptoms

53
Q

Factitious disorder features?

A
  1. conscious production of symptoms with intent to deceive but UNCONSCIOUS OF GAIN
  2. wants to be in the sick role
  3. dependent personality
  4. munchausens

Psych (23 decks)

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