Medical Illnesses with Psych symptoms

Question 1

medical or mental

Answer 1

mind and body are not dualistic, they are intertwined
client is holistic entity
new medical diagnosis or illness is stressful and life changing
pt’s being prepared for medical or surgical problems may display behaviors of aggression, depression, anxiety, anger, suspicion, psychosis
identification of a medical condition can be challenging, especially in an individual with an existing psychiatric condition

Question 2

medical mimics

Answer 2

disorders that present with psychiatric symptoms directly resulting from an underlying medical condition. The cause of psychiatric symptoms is medical illness

Question 3

diagnostic overshadowing

Answer 3

attributing symptoms of a physical illness to the mental illness

Question 4

medical mimics associated with mood disorders

Answer 4

cushings disease
dementia
fibromyalgia/ chronic fatigue syndrome
hyper/hypothyroidism
sleep apnea
mononucleosis

Question 5

psychotic disorder due to another medical condition

Answer 5

hallucinations
delusions
disorganized speech and thought patterns
symptoms of a medical condition not associated with mental disorders that may cause psychosis, such as schizophrenia spectrum disorder
symptoms may be temporary and brief or long-term, persisting long after associated medical condition has been resolved.

Question 6

mimics associated with anxiety

Answer 6

cushings disease
hyper/hypothyroidism

Question 7

psychiatric side effects from pharmacological treatment

Answer 7

often resemble spontaneous psychiatric syndromes
occurs with usual doses, intoxication, or withdrawal of treatment
range from short-lasting anxiety to severe confusion
suicide

Question 8

risk factors for Psychiatrics side effects

Answer 8

polypharmacy
high doses
route of administration
faster administration
narrow therapeutic index
metabolic conditions (hepatic insufficient, slow metabolizer)
augmented permeability of blood-brain barrier
very young or elderly patients
postpartum or other situations of stress (ICU)

Question 9

medications with induction of a psychoactive state

Answer 9

anti-hypertensives
oral contraceptives
steroids
cancer chemo agents
benzodiazepines
barbiturates
histamine 2 blockers

Question 10

commonly abused substances

Answer 10

alcohol
opioids
amphetamines: Ecstasy, meth
cocaine
benzo’s
barbiturates
steroids
LSD

Question 11

hallmark risk factors of a medical mimic

Answer 11

normal functioning prior to sudden onset of mental symptoms
late onset of initial presentation
known underlying medical condition
atypical presentation of a specific psychiatric diagnosis
disturbance of gait, balance, or both
visual, olfactory, or tactile hallucinations
illicit or recent substance use

Question 12

high risk individuals for medical mimic

Answer 12

elderly
patients with a history of substance abuse
patient without history of psychiatric illness
patients with pre-existing medical illness
patients from lower socioeconomic strata

Question 13

lab and metabolic assessments

Answer 13

pulse ox
cmp
cbc
therapeutic drug levels
blood alcohol level
UA and UDS
TSH, T3, T4
ESR, CRP
screening for syphilis, lyme dz, lupus, and demyelinating d/o
AIDS/ HIV

Question 14

nursing implications of mimics

Answer 14

remember client is a holistic entity
be aware of medical mimics and understand that common psych symptoms often arise from medical illnesses
emotional dimensions of medical condition may be overlooked
provide reassurance and support
be sensitive to emotional experiences of clients with medical illnesses
accurate history and physical exam
ask about substance abuse
review meds and any otc
monitor labs and report abnormals asap
ask women about eating habits and diet pills