Approach to Psychosomatic Disorders

Question 1

What are the two basic assumptions in Psychosomatic medicine ?

Answer 1

1. unit of mind and body
2. psychological factors must be considered in all disease states

a holistic approach to medicine!

Question 2

what is psychosomatic medicine?

Answer 2

a medical condition separate from a mental disorder that is present

mental/psychological factors adversely affect general medical conditions

Question 3

what is an independent risk factor for coronary heart disease, is associated with increased risk of subsequent stroke and diabetic symptoms

Answer 3

depression

Question 4

what mood disorder is a risk factor for asthma, coronary artery disease, and specific phobias

Answer 4

anxiety

Question 5

what mood disorder impaired presentation and treatment of symptoms of a plethora of health conditions

Answer 5

schizophrenia

Question 6

what disorder can cause maladaptive health behaviors like over eating, unsafe sex or be in denial of the need for surgery even with cancer

Answer 6

personality disorders

Question 7

what is stress

Answer 7

a circumstance that disturbs or is likely to disturb normal physiological/psychological functioning of a person

Question 8

describe the stress theory: what is set into motion first

Answer 8

the sympathetic nervous system increases, heart rate, blood pressure, and cardiac output

Question 9

how does the body respond to stress

neurotransmitters:

endocrine response:

immune response:

life events:

Answer 9

tries to maintain homeostasis

neurotransmitters: release catecholamines, increase serotonin, increase steroids, increase dopamine

endocrine response: increase ACTH, promotes energy

immune response: inhibited

life events: increased chance of mental illnesses

Question 10

medical symptoms of lupus

psychiatric symptoms of lupus

Answer 10

medical: photosensitivity, butterfly rash, joint pain, fever

psych: depression, mood disturbances, psychosis, delusions

Question 11

medical symptoms of MS:

psychiatric symptoms of MS:

Answer 11

medical: motor and sensory disturbances, impaired vision (optic neuritis) ,remissions and exacerbations, slurred speech

psych: anxiety, euphoria, mania

Question 12

medical symptoms of seizure

psychiatric symptoms of seizure:

Answer 12

medical: sensory distortions, delirium, memory loss

psychiatric symptoms: confusion, psychosis, dissociative states, belligerence, catatonic like state

Question 13

_ can cause CAD/MI and CAD/MI can cause _

Answer 13

depression

depression

Question 14

30% of asthmatics meet criteria for _

Answer 14

agoraphobia/panic disorder

fear of dyspnea can trigger asthma attacks and anxiety

Question 15

anxiety disorder and panic disorder have a high level in what chronic respiratory disease

Answer 15

COPD

Question 16

hyperthyroidism medical symptoms

hyperthyroidism psychiatric symptoms

Answer 16

medical symptoms: heat intolerance, excessive sweating, diarrhea, weight loss, tachycardia, palpitations, vomiting, tremor , short attention span. bulging eyes

psy: nervousness, excitability, irritability, psychosis, visual hallucinations, insomnia

Question 17

hypothyroidism medical symptoms

hypothyroidism psychiatric symptoms

Answer 17

medical: cold intolerance, dry skin, constipation, weight gain

psych: leathery, depressed, personality change, paranoia

Question 18

medical and psych symptoms of diabetes

Answer 18

medical: increased urination/thirst, glucose is high

psych: depression

Question 19

pheochromocytoma medical and psych symptoms

Answer 19

medical: paroxysmal hypertension, headaches, sweating, tremor

psych: anxiety, apprehension, feeling of impeding doom, panic

Question 20

hyponatermia medical and psych symptoms:

Answer 20

medical: excessive thirst, polydipsia, stupor, coma, seizures

psych: confusion, lethargy, personality changes

Question 21

thiamine def medical and psychiatric symptoms

Answer 21

medical: neuropathy, cardiomyopathy, wernicke syndrome

psych: poor concentration, confusion, confabulation

Question 22

cobalamin vitamin B12 def medical and psych symptoms

Answer 22

medical: pallor, dizziness, peripheral neuropathy, dorsal column signs, (if levels less than 400)

psych: irritability, inattentiveness, psychosis, dementia

Question 23

copper can cause

Answer 23

psychosis

Question 24

vitamin A and D, and iron can all cause

Answer 24

confusion

Question 25

B6 and B12 affect

Answer 25

peripheral nerve function

Question 26

lead can cause

Answer 26

cognitive dysfunction

Question 27

Peptic ulcer disease leads to increase _ _ excretion which can be associated with psychological stress

Answer 27

gastric acid

Question 28

ulcerative colitis shows increased prevalence of

Answer 28

dependent personality disorders

Question 29

churns disease has high rates of preexisting

Answer 29

panic disorder

Question 30

some of the most common side effects of antidepressants are

Answer 30

gi disturbances; nausea and diarrhea

Question 31

TCA side effects

Answer 31

constipation and dry mouth

Question 32

medical symptoms and psychiatric symptoms of acute intermittent porphyria

Answer 32

medical: abdominal pain, consitpation, peripheral neuropathy, paralysis psych: acute depression, agitation, paranoia

Question 33

medial symptoms and psych symptoms of hepatic encephalopathy

Answer 33

medical: asterisks, spider angioma, polar erythema, lover enlargement, ecchymosis psy: supporta, disinhibition, psychosis, depression

Question 34

psoriatic episodes are related to _ events

Answer 34

stressful

Question 35

medical symptoms of brain neoplasms psych symptoms

Answer 35

medical: headache, papilledema, vomiting, focal neurological deficit psych: personality changes depending on location

Question 36

frontal lobe tumor causes changes in what

Answer 36

mood, irritability, judgement, speech, smell, memory

Question 37

occipital lobe tumors present with

Answer 37

visual hallucinations and aura

Question 38

head trauma medical and psych symptoms

Answer 38

medical: headache, bleeding from ear, altered LOC, neurological findings (location based as well) psych: confusion, personality changes, memory problems, agitation

Question 39

PCP intoxication medical symptoms psych symptoms

Answer 39

medical: elevated BP, vertical and horizontal nystagmus, muscular rigidity, vomiting psych: agitation with a blank stare, anxiety, stupor, aggression, panic, bizarre strength (pick up car?)

Question 40

cocaine/amphetamine inoxication medical symptoms: psych symptoms:

Answer 40

medical: elevated BP, tachycardia, dilated pupils, sweating, tremor psych: agitation with delusions, euphoria with irritability

Question 41

LSD intoxication medical symptoms psych symptoms

Answer 41

medical : sympathetic overdrive psychL sensory distortion, hypersensitivity of senses, hallucinations

Question 42

the study, practice, and teaching of the relationship between medical and psychiatric disorders psychiatrists serve as consultants in hospital settings to bridge between psychiatry and other specialties

Answer 42

consultation liaison

Question 43

what are some common reasons a consultation liaison would be used

Answer 43

suicide attempt/threat depression agitation hallucinations sleep disorder confusion

Question 44

_ is the most common cause of hallucinations

Answer 44

delirium tremens

Question 45

_ is the most common cause of confusion or disorientation among hospitalized patients

Answer 45

delirium

Question 46

delirium is common in what population

Answer 46

elderly, ICU patients educate pt and family about this proper to hospitalization

Question 47

reversible acute onset of impaired cognition , attention, consciousness, perception, sleep patterns (day vs. night) , and emotional states that fluctuate

Answer 47

delirium

Question 48

what are some interventions we can use to mitigate delirium

Answer 48

orientation protocols with the use of clocks and calendars cognitive stimulation ( vitas from friends/family during the day) facilitate psychologic sleep (avoid at night)

Question 49

avoid _ (medication) in elderly hospialized patients

Answer 49

benzodiazepines

Question 50

1.One or more somatic symptoms that are distressing or result in significant disruption of daily life. 2.Excessive thoughts, feelings, or behaviors related to the somatic symptoms or associated health concerns as manifested by at least one of the following: 1. Disproportionate and persistent thoughts about the seriousness of one’s symptoms. 2. Persistently high level of anxiety about health or symptoms. 3. Excessive time and energy devoted to these symptoms or health concerns. 3.Although any one somatic symptom may not be continuously present, the state of being symptomatic is persistent (typically more than 6 months).

Answer 50

somatoform disorder (pain disorder) -somatic symptom disorder

Question 51

how do we treat somatoform disorder

Answer 51

have a good relationship with the patient have a team approach CBT anti anxiety medications

Question 52

conversion disorder

Answer 52

following times of high stress neurological voluntary motor or sensory problems arise

Question 53

symptoms of conversion disorders

Answer 53

* Paresthesias and anesthesias * Weakness * Paralysis *Pseudoseizures/psychogenicseizures * Involuntary movements (e.g. tremors, tics) * Sensory disturbances * Blindness * Mutism

Question 54

illness anxiety disorder

Answer 54

hypochondriac (ME) fear of something being medically wrong for no reason essentially or I have a cold, and think I have cancer (out of proportion)

Question 55

factitious disorders

Answer 55

intention fabrication of medical symptoms not for secondary gain

Question 56

munchausens

Answer 56

factious disorder where you are giving yourself medical symptoms vs proxy- giving medical conditions to someone else

Question 57

malingering

Answer 57

intention fabrication of medical symptoms with evidence of secondary gain ( fabricating symptoms to get disability approved)