Clinical Approach to Psychosomatic Disorders

Question 1

DSM5 criteria for psych factors affecting medical conditions

Answer 1

a medical condition separate from the mental disorder is present

psych factors adversely affect the general medical condition

Question 2

psychosomatic effects of depression

Answer 2

increased risk for:
coronary artery disease
stroke
DM

Question 3

psychosomatic effects of anxiety

Answer 3

increased risk for:
CAD
asthma
specific phobias

Question 4

describe the stress theory

Answer 4

stress stimulates the sympathetic ANS and puts organs in “fight or flight” mode

tachy
HTN
increased CO

Question 5

physiologic response to stress

Answer 5

neurotransmitter release: catecholamines, serotonin, glucocorticoids and DA

endocrine response: CRF triggers ACTH

immune response inhibition

Question 6

psych sx of SLE

Answer 6

depression
mood disturbances
psychosis
delusions
hallucinations

Question 7

psych sx of MS

Answer 7

anxiety
euphoria
mania

Question 8

psych sx of seizure DOs

Answer 8

confusion
psychosis
dissociative states
catatonic-like state
bizarre behavior

Question 9

psych sx of asthma and COPD

Answer 9

panic disorder

anxiety

Question 10

psych sx of hyperthyroidism

Answer 10

nervousness
excitability
irritability
pressured speech
insomnia
psychosis
visual hallucinations

Question 11

psych sx of hypothyroidism

Answer 11

depression
lethargy
personality change
paranoia

Question 12

psych sx of DM

Answer 12

frustration
loneliness
dejection
depression

Question 13

psych sx of pheochromocytoma

Answer 13

anxiety
apprehension
feeling of impending doom
panic

Question 14

psych sx of hyponatremia

Answer 14

confusion
lethargy
personality changes

Question 15

psych sx of thiamine def

Answer 15

poor concentration
confusion
confabulation

Question 16

psych sx of cobalamin def

Answer 16

irritability
inattentiveness
psychosis
dementia

Question 17

describe the link between GI and psych

Answer 17

psychological stress is strongly associated with increased gastric acid excretion = PUD

psych drugs have a high rate of GI disturbance due to serotonin in GI tract

Question 18

psych sx of pancreatic CA

Answer 18

depression
lethargy
anhedonia
apathy
decreased energy

Question 19

psych sx of porphyria

Answer 19

depression
agitation
paranoia
visual hallucinations

Question 20

psych sx of hepatic encephalopathy

Answer 20

euphoria
disinhibition
psychosis
depression

Question 21

what psych disorders are associated with skin disorders?

Answer 21

anxiety
depression
chronic stress

Question 22

psych sx of frontal lobe tumor

Answer 22

mood changes
irritability
facetiousness
impaired judgment
impaired memory
delirium
loss of speech and smell

Question 23

psych sx of occipital lobe tumor

Answer 23

aura

visual hallucinations

Question 24

psych sx of head trauma

Answer 24

confusion
personality changes
memory impairment

Question 25

stress management tx

Answer 25

self-observation
cognitive restructuring
relaxation exercises
mindfulness

Question 26

what is consultation-liaison psychiatry?

Answer 26

the study, practice and teaching of the relationship between medical and psych disorders

Question 27

delirium

Answer 27

reversible, acute onset of impaired cognition, attention, consciousness, perception, sleep patterns of emotional states that fluctuate over the course of the day

Question 28

delirium interventions

Answer 28

orientation protocols
cognitive stimulation
facilitate sleep patterns

*avoid benzos in the elderly!!!

Question 29

psych sx of PCP abuse

Answer 29

agitation with blank stare
anxiety
stupor
aggression
panic
bizarre behavior

Question 30

psych effects of corticosteroids

Answer 30

mania

psychosis (hallucinations)

Question 31

psych effects of benzos

Answer 31

sedation

paradoxical agitation

Question 32

psych effects of antiparkinson’s meds

Answer 32

psychosis
mania
anxiety

Question 33

psych effects of antidepressants

Answer 33

mania (bipolar pt)
anxiety
insomnia