Introduction to Psychiatry

Question 1

What is the prevalence of post-stroke psychosis?

Answer 1

• Delusions 4.67% (95% CI 2.30% to 7.79%)

* Hallucinations 5.05% (95% CI 1.84% to 9.65%).

Question 2

In which hemisphere strokes is post-stroke psychosis more common?

Answer 2

right (5:1)

Question 3

What are the common delusional. themes in post-stroke psychosis?

Answer 3

• Persecutory
• Jealousy
• Environment

Question 4

What is the overlap between physical illness and mental illness?

Answer 4

1. 30% England long term condition
2. 30% of people with a long term condition have mental health problem
3. 20% of population have mental health problem
4. 46% of people with a mental health problem have a long term condition

Question 5

What are examples of physical illness associated with mental health symptoms?

Answer 5

1. cardiovascular diseases 3x risk of depression and anxiety
2. Diabetes 2x risk of depression
3. Chronic obstructive pulmonary disease 10x risk of panic disorder
4. Muscloskeletal disorders 2x risk of depression

Question 6

What are examples of physical illness causing discrete mental illness?

Answer 6

1. Thyrotoxicosis to anxiety, mania
2. Thyroid deficiency to depression, dementia
3. Cushings diseaseto depression
4. Infections (syphilis, HIV)to Psychosis
5. Cancer to depression
6. Parkinson’s diseaseto depression, anxiety, dementia

Question 7

What affects how people with chronic mental illness are at a greater risk of physical illness?

Answer 7

• Diet and exercise
• Smoking, alcohol and drugs
• Medication + side effects?
• People with chronic mental illness die 20 years younger than the general population.

Question 8

What factors may affect timely diagnosis of physical disorders in people with mental illness?

Answer 8

• Timely diagnosis and treatment affected by
• Illness behaviour
• Diagnostic overshadowing
• Stigma
• Lack of resources

Question 9

What is the prevalence of delirium?

Answer 9

• 20% acute hospital patients >65 on admission
• 20% more develop delirium after admission
• Overall prevalence 30% on wards, 80% in intensive care
• 50% undetected !!!!!
• 50% “hypoactive”

Question 10

What is delirium?

Answer 10

• a psychiatric manifestation of a physical illness
• Sudden onset fluctuating confusion and inattention
• Also known as acute confusional state

Question 11

Why is delirium important?

Answer 11

• Delays discharge

* Increases mortality

Question 12

What are some causes of delirium?

Answer 12

•Infection (Urine, pneumonia, cellulitis, wound etc)
•Change in environment (ITU, HDU, ward)
•Medication (opiates, anticholinergics, steroids)
•Alcohol withdrawal
•Surgery
•Pain 
-Liver/renal impairment
-Hypoxia
-Hyponatraemia
-Stroke
-Encephalitis
-Constipation 
-Urine retention
-Dehydration

Question 13

What are some predisposing factors for delirium?

Answer 13

1. Advanced age
2. Dementia (often undetected)
3. Impaired activities of daily living
4. Immobility
5. Sensory impairment (teeth, glasses, hearing aids)
6. Urinary catheterization
7. Malnutrition
8. Alcohol
9. Depression

Question 14

What is the management of delirium?

Answer 14

1. Anticipate
2. Modify risk factors if possible
3. Early diagnosis
4. Treat the causes
5. Good nursing;
   - Single room, well lit, familiar staff/family (in an ideal world)
6. Medication
7. Wait!

Question 15

What is stigma?

Answer 15

refers to challenges faced by people with mental illness related to knowledge, attitudes, and behaviour of people they meet

Question 16

Why is does stigma happen?

Answer 16

1. Poor understanding of mental health
2. Negative attitude
3. Social exclusion
4. Pervasive and widespread
5. 75% people with mental illness experience stigma

Question 17

What is interpersonal stigma?

Answer 17

• Direct effect on the individual
• Internalised discrimination
• Compounded by direct effects of illness

Question 18

How is physical and mental health related?

Answer 18

• Physical illness may cause mental illness (e.g. Parkinsons, stoke, thyroid disease)
• Mental illness may.be present with physical symptoms (e.g. Depression, anxiety)
• Physical illness may present as mental illness (e.g. delirium, mania

Question 19

What is an adjustment reaction?

Answer 19

1. States of subjective distress and emotional disturbance, usually interfering with social functioning and performance
2. arising in the period of adaptation to a significant life change or a stressful life event.….
3. The manifestations vary and include depressed mood, anxiety or worry (or mixture of these), a feeling of inability to cope, plan ahead, or continue in the present situation, as well as some degree of disability in the performance of daily routine

Question 20

What is an organic delusional disorder (symptoms started after stroke)?

Answer 20

1. A disorder in which persistent or recurrent delusions dominate the clinical picture
2. The delusions may be accompanied by hallucinations
3. Some features suggestive of schizophrenia, such as bizarre hallucinations or thought disorder, may be present

Question 21

What is delirium?

Answer 21

• organic cerebral syndrome characterized by concurrent disturbances of consciousness and attention, perception, thinking, memory, psychomotor behaviour, emotion, and the sleep-wake schedule
• The duration is variable and the degree of severity ranges from mild to very severe

Question 22

Is there only one cause of delerium?

Answer 22

Often multiple medical causes

Question 23

How stigma increase discrimination?

Answer 23

1. Increases the disability caused by mental illness

2. Creates disadvantage with personal relationships, education, and work

Question 24

What is interpersonal stigma?

Answer 24

• Family
• Friends
• Colleagues

Question 25

What is structural stigma?

Answer 25

• Poor resources and funding

* Access to physical health care