Clinical Approach to Psychosomatic Disorders Flashcards
(26 cards)
Psychosomatic medicine has 2 major assumptions. What are they?
- Unity of mind and body.
2. Psychological factors must be considered in all disease states.
Use Mood Disorder as a example of psychosomatic disorder
Mood disorder
- Depression: independent risk factor for coronary heart disease.
- > poor outcomes for CHD
- > recurrent coronary events
- > impaired functioning
- > poorer quality of life
- > increased mortality
- associated with increased risk of stroke
- a number of depressive symptoms are related to the number of diabetic symptoms.
What medical risks are associated with Mood Disorders: Anxiety?
Coronary heart disease
Asthma
Specific phobias
What medical risks are associated with personality traits or coping style?
Pathological denial of need for surgery in patients with cancer.
What medical risks are associated with maladaptive coping behaviors?
Overeating
Lack of exercise
Unsafe sex practices
What is Stress Theory?
Stress: a circumstance that disturbs, or is likely to disturb, the normal physiological or psychological functioning of a person.
Stimulation of autonomic nervous system, particularly the sympathetic nervous system:
->Tachycardia, Hypertension, Increased CO, which results in more stress.
Body puts into motion a set of responses that seeks to diminish the impact of the stressor and restore homeostasis.
What are the NT responses to stress? (4)
+ NE systems: release catecholamines
+ Serotonin systems: increased serotonin turnover
Glucocorticoids enhance serotonin function
Increased DA neurotransmission
What are the endocrine responses to stress?
+ Corticotropin-releasing factor: CRF (hypothalamus) triggers release of ACTH.
-> promotes energy use, increased CV activity and inhibiting growth, reproduction and immunity.
How are life events “measured”?
Social readjustment scale
What disorders of the MSK system are effected by stress? (3)
- SLE
- medical symptoms: fever, photosensitivity, butterfly rash, arthralgias, HA.
- psychiatric symptoms: depression, mood changes, psychosis, etc.
* treated with supportive psychotherapy. - Multiple Sclerosis
- medical symptoms: transient motor/sensory disturbances, impaired vision, diffuse neurological signs with remissions and exacerbations, slurred speech, incontinence.
- psychiatric symptoms: anxiety, euphoria, mania. - Seizure Disorder
- medical symptoms: sensory distortions, violence, belligerence.
- psychiatric symptoms: confusion, psychosis, dissociative states, catatoniclike state, bizarre behavior.
What disorders of the CVS are effected by stress? (4)
- Coronary heart disease - 2-fold increased risk for MI and CAD-related mortality.
- Arrhythmias and sudden cardiac death - autonomic cardiac modulation is sensitive to acute emotional stress.
- HTN
- Heart transplantation
What disorders of the respiratory system are effected by stress? (2)
- Asthma - 30% meet criteria for panic disorder or agoraphobia. Fear of attach can trigger anxiety.
- COPD
What disorders of the endocrine system are effected by stress? (4)
- Hyperthyroidism
- Hypothyroidism
- DM - depression**
- Pheochromocytoma
What disorders of the metabolic system are effected by stress? (3)
- Hyponatremia
- Vitamin deficiencies
- Thiamine deficiency: confabulation, confusion, poor concentration.
- Cobalamin (vit. B12) deficiency
What are the psychiatric effects of the following toxicities:
Vitamins A, D and Iron
Cu
Vitamins B6 and B12
Lead
Vitamins A, D and Iron: confusion
Cu: psychosis
Vitamins B6 and B12: peripheral nerve function
Lead: cognitive dysfunction
What disorders of the GI system are effected by stress? (3)
- PUD: increased acid secretions associated with stress.
- UC: high prevalence with dependent personalities.
- CD: high rates of preexisting panic disorder.
What kind of side-effects are most common with antidepressants?
TCAs?
GI-related due to serotinin’s role in GI tract.
- > N/V and diarrhea
- usually early on and dose-related
TCA side-effects tend to be anticholinergic: constipation and dry mouth.
What disorders of the hepatic/pancreatic system are effected by stress? (3)
- Pancreatic carcinoma
- Acute intermittent porphyria
- Hepatic encephalopathy
What disorders of the integumentary system are effected by stress? (3)
- Atopic dermatitis: increased prevalence with anxiety and depression.
- Psoriasis: related to anxiety, depression and personality disorders.
- Urticaria: related to anxiety and depression.
What tumors are effected by stress? (3)
- *Frontal lobe tumor: mood changes, irritability, facetiousness, impaired judgment, impaired memory, delirium, loss of speech, loss of smell.
- Occipital lobe tumor: aura and visual hallucinations.
- Brain neoplasms: personality changes.
What is treatment of psychosomatic disorders based around?
What are 4 means of therapy/treatment for psychosomatic disorders?
Stress management!
Self-Observation: Daily diary to keep record of stressors and reactions to stressors.
Cognitive Restructuring: Includes cognitive behavior therapy to substitute negative assumptions with positive assumptions.
Relaxation Exercises: Muscle relaxation techniques to teach relaxation to stressed/tense muscles.
Mindfulness: a mental state achieved by focusing one’s awareness on the present moment, while calmly acknowledging and accepting one’s feelings, thoughts, and bodily sensation.
What is Consultation-Liason Psychiatry?
What problems do these psychiatrists often deal with? (6)
The study, practice, and teaching of the relation between medical and psychiatric disorders.
- Suicide attempts/threats
- Depression
- Agitation: dementia
- Hallucinations: delirium tremens (most common cause of hallucinations)
- Sleep disorder
- Confusion: delirium (most common cause of confusion in hospitalized pts. in general hospital)
What 3 interventions can mitigate risk factors of delirium?
What absolutely MUST be avoided in elderly patients with delirium?
Orientation protocols - use clocks, windows, etc.
Cognitive stimulation - family visits, just avoid at nighttime.
Facilitate physiological sleep - avoid procedures/meds during sleeping hours. Reduce nighttime noise.
*MUST avoid Benzodiazepines in the elderly w/ delirium!
What are the medical and psychiatric symptoms of PCP?
Medical Symptoms: Elevated BP, tachycardia, nystagmus, muscular rigidity, vomiting.
Psychiatric Symptoms: Agitation with blank stare, anxiety, stupor, aggression, panic, bizarre behavior.
