mental disorders and physical health

Question 1

what is adjustment disorder

Answer 1

-Recent psychosocial stressors (illness and move into care)
-Mood changes and focusing on stressors

-Typically resolves after 6 months
-Psychotic symptoms typically not seen

Question 2

what is Psychotic depression

Answer 2

-Recent psychosocial stressors
-Older age and chronic medical conditions are risk factors

-No other core features of depression (anergia, anhedonia) or biological symptoms reported
-Paranoid psychosis rare. Typically a mood congruent psychosis is seen (delusions of nihlism, guilt, Cotard’s syndrome)
-Visual hallucinations uncommon

Question 3

what is Behavioural and psychological symptoms of dementia (BPSD)

Answer 3

-recent stoke
-Delusions and hallucinations
-Ongoing vascular risk factors and advancing age (main risk factor for dementia)

-Normal score on MoCA
-No cognitive concerns raised by carers
-BPSD typically a feature of more advanced disease

Question 4

what is post stroke psychosis- where it occurs, typical symptoms and management

Answer 4

-commonly after right MCA lesion affecting frontal and temporal regions
-delusion
-auditory hallucinations (followed by visual)

managemnt:
-some response to antipsychotic

Question 5

antipsychotic use in those with dementia increases the risk of what?

Answer 5

stroke

Question 6

common type of delusion in post stroke psychosis

Answer 6

persecutory or jealous type (Othello’s syndrome)

Question 7

physical illness causing mental illness -addison’s disease

Answer 7

depression, poor concentration, irritability

Question 8

physical illness causing mental illness -hyperglycaemia

Answer 8

depression, anxiety

Question 9

physical illness causing mental illness -hyperthyroidism ✯

Answer 9

anxiety, mania

Question 10

physical illness causing mental illness -hypothyroidism✯

Answer 10

depression, cognitive impairment

Question 11

physical illness causing mental illness - cushing’s syndrome✯

Answer 11

depression

Question 12

physical illness causing mental illness -HIV

Answer 12

psychosis, dementia

Question 13

physical illness causing mental illness -SLE

Answer 13

depression

Question 14

physical illness causing mental illness - cancer

Answer 14

depression

Question 15

physical illness causing mental illness -parkinson’s disease✯

Answer 15

depression , anxiety, dementia, psychosis

Question 16

physical illness causing mental illness -phaeochromocytoma✯

Answer 16

anxiety

Question 17

physical illness causing mental illness -dementia✯

Answer 17

psychosis, aggression/violence, depression, anxiety

Question 18

physical illness causing mental illness - Huntington’s disease✯

Answer 18

psychosis, aggression/violence, cognitive impairment, depression, anxiety

Question 19

medication adverse effects- dopamine agonist✯

Answer 19

psychosis

Question 20

medication adverse effects-L-dopa

Answer 20

psychosis, delirium, anxiety, depression

Question 21

medication adverse effects- steroids (prednisolone) ✯

Answer 21

depression, mania, psychosis, anxiety

Question 22

medication adverse effects-isoniazid (Tb ab)

Answer 22

mania, psychosis

Question 23

medication adverse effects-anticholinergics✯

Answer 23

delirium, anxiety, psychosis

Question 24

medication adverse effects-isotretinoin (roaccutane)

Answer 24

depression

Question 25

medication adverse effects-digoxin

Answer 25

depression, psychosis

Question 26

medication adverse effects- Interferon alpha

Answer 26

depression, mania, psychosis

Question 27

what is the mortality gap

Answer 27

people with chronic mental illness are at greater risk of all cause mortality

Question 28

cause of mortality gap/impact on physical health with those with mental illness

Answer 28

-med adverse effects (ie. weight gain, sedation)
-increase smoking, alcohol rate
-poor diet and exercise
-chaotic life style and low socioeconomic status

Question 29

management of mortality gap/impact on physical health with those with mental illness

Answer 29

-choose medication that minimise impact on physical health
-monitor cardiometabolic factors (ie MBI/HbA1c)
-smoking cessation
-dietary advice
-drugs and alcohol support service

Question 30

what is delirium

Answer 30

acute confusion state and neuropsychiatric manifestation of physical illness/injury/intervention

can be considered as ‘acute brain failure’ compared to ‘chronic brain failure’ - dementia

Question 31

3 types of delirium

Answer 31

hyperactive- agitation, hallucination, inappropriate behaviour

hypoactive-lethargy, reduced concentration, reduced alertness, reduced oral intake

mixed-combo of above

Question 32

risk factor of delirium

Answer 32

older people
frail
poor nutrition
cognitive impairment etc

Question 33

common cause of delirium

Answer 33

Physical illness or injury

(e.g. infection, constipation, urinary retention, electrolyte disturbance, pain, acute vascular events, dehydration

Question 34

pathological cause of delirium

Answer 34

poorly understood and likely multi-factorial

Delirium involves various brain processes like inflammation, vascular dysfunction, altered metabolism, neurotransmitter imbalance, and impaired connectivity

Question 35

delirium management

Answer 35

1. address modifiable risk factors

2.optimise co-morbidities treatment

3.treat underlying cause

4.re-orientation strategy

5.normalise sleep-wake cycle

6. maintain safe mobility to avoid falls

Question 36

what to do in challenging behaviours in delirium

Answer 36

-verbal and non-verbal de-escalation technique
-in extremis- short term pharmacological interventions (ie. low dose Haloperidol [0.5mg] for<7days)

Question 37

what affects diagnosis of physical disorders in people with mental illness

Answer 37

-illness behaviour (ie. poor insight/mistrust in others, chaotic lifestyle)
-diagnostic overshadowing (misattribution of physical symptoms to psychiatric symptoms)
-lack of resources/access to service (low socio-economic status=RF for mental disorder development)