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Flashcards in Psychosomatic Medicine Deck (36):
1

Stress effect on the immune system?

Stress increases the release of ACTH --> Release of cortisol --> Depression of the immune system (decr. lymphocyte response to mitogens and antigens + impaired function of NK cells).

2

Magnitude of stress associated with selected life events according to the Holmes and Rahe Social Readjustment Scale - Very high stressfulness:

1. Death of a spouse (100).
2. Divorce (73).
3. Marital seperation (65).
4. Death of a close family member (63).

3

Magnitude of stress associated with selected life events according to the Holmes and Rahe Social Readjustment Scale - High stressfulness:

1. Major personal loss of health because of illness or injury (53).
2. Marriage (50).
3. Job loss (47).
4. Retirement (45).
5. Major loss of health of a close family member (44).
6. Birth or adoption of a child (39).

4

Magnitude of stress associated with selected life events according to the Holmes and Rahe Social Readjustment Scale - Moderate stressfulness:

1. Assuming major debt (eg taking out a mortgage) (31).
2. Promotion or demotion at work (29).
3. Child leaving home (29).

5

Magnitude of stress associated with selected life events according to the Holmes and Rahe Social Readjustment Scale - Low stressfulness:

1. Changing residence (20).
2. Vacation (15).
3. Major holiday (12).

6

The need for social readjustment is directly correlated with increased risk of medical and psychiatric illness; in studies by Holmes and Rahe, 80% of patients with a score of ...?

300pts in a given year became ILL during the next year.

7

Other psychosomatic relationships - Medical conditions not uncommonly present with psychiatric symptoms - Conditions that present with DEPRESSION + ANXIETY include:

1. Neurologic diseases (eg dementia).
2. Neoplasms (particularly pancreatic or other GI cancers).
3. Endocrine and enzyme disturbances (eg hypothyroidism, diabetes).
4. Viral illnesses (eg AIDS).
5. Blood abnormalities, hypoglycemia, and pheochromocytoma.

8

Other psychosomatic relationships - Medical conditions not uncommonly present with psychiatric symptoms - Conditions that present with PERSONALITY CHANGES + PSYCHOTIC SYMPTOMS include:

1. Neurological illness (eg temporal lobe epilepsy).
2. Tertiary syphilis.
3. Wilson disease.
4. AIP.
5. CTD (SLE).
6. HD.
7. AIDS.
8. Cushing.
9. MS.

9

Nonpsychotropic medications can produce psychiatric symptoms:

1. Confusion --> Antiasthmatics.
2. Anxiety and agitation --> Anti-PD agents.
3. Depression --> Anti-HTN.
4. Sedation --> Anti-Histamines.
5. Psychotic symptoms --> Analgesics, antibiotics, antihistamines, steroid hormones.

10

Selected vitamins and minerals - Neuropsychological Symptoms of Toxicity and their Management - VitA - Toxicity:

Incr. ICP --> Headache, altered mental status, neurological deficits.

11

Selected vitamins and minerals - Neuropsychological Symptoms of Toxicity and their Management - B6 - Toxicity:

1. Depression.
2. Peripheral neuropathy.

12

Selected vitamins and minerals - Neuropsychological Symptoms of Toxicity and their Management - B12 - Toxicity:

Tingling and burning sensation in the extremities.

13

Selected vitamins and minerals - Neuropsychological Symptoms of Toxicity and their Management - VitD - Toxicity:

1. Confusion.
2. Apathy.
3. Poor appetite.
4. Thirst.

14

Selected vitamins and minerals - Neuropsychological Symptoms of Toxicity and their Management - Iron (found in prenatal vitamins) - Toxicity:

1. Confusion.
2. Seizures.
3. Retardation.
4. Vomiting "coffee grounds".

15

Selected vitamins and minerals - Neuropsychological Symptoms of Toxicity and their Management - Lead - Toxicity:

1. Depression.
2. Cognitive deficits.
3. Hyperactivity.
4. Aggression.

16

Selected vitamins and minerals - Neuropsychological Symptoms of Toxicity and their Management - Cu - Toxicity:

Inappropriate or psychotic behavior.

17

Selected vitamins and minerals - Neuropsychological Symptoms of Toxicity and their Management - Zinc (found in denture creams):

Nerve damage leading to feelings of burning, numbness, and weakness.

18

Psychological stress in specific patient populations - Consultation-liaison (CL) psychiatry?

For severe psychiatric problems (eg psychotic symptoms) in hospitalized patients.

19

Hospitalized patients - Common psychological complaints in hospitalizes patients include:

1. Anxiety.
2. Sleep disorder.
3. Disorientation.
often as a result of delirium and depression.

20

Hospitalized patients - Patients who are at the greatest risk for such problems include those ...?

1. Undergoing surgery.
2. Renal dialysis.
3. ICU patients or CCU (coronary care unit).
--> IN ALL GROUPS = Elderly are at increased risk.

21

Patients undergoing surgery who are at greatest psychological and medical risk are those who ...?

1. Believe that they will NOT survive surgery.
2. Those who DO NOT admit that they are worried before surgery.

22

Psychological and medical risk can be reduced by ...?

Enhancing SENSORY + SOCIAL input:
1. Placing the patient's bed near a window.
2. Encouraging the patient to talk.
3. Providing info on what the patient can expect during and after a procedure.
4. Allowing patient to control the environment as much as possible.

23

Patients undergoing renal dialysis are at increased risk for psychological problems (eg depression, suicide, and sexual dysfunction) in part because ...?

Their lives depend on other people and on technology.

24

Patients undergoing renal dialysis - Psychological and medical risk can be reduced through the use of ...?

In-home dialysis units, which cause less disruption of the patient's life.

25

Patients with chronic pain - Psychosocial factors - Chronic pain:

Pain lasting >6 months - Commonly encountered complaint of patients.

26

Decreased tolerance for pain is associated with:

1. Depression.
2. Anxiety.
3. Life stress in adulthood.
4. Physical and sexual abuse in childhood.

27

Pain tolerance can be increased through:

1. Biofeedback.
2. Physical therapy.
3. Hypnosis.
4. Psychotherapy.
5. Meditation.
6. Relaxation training.

28

Chronic pain often leads to ...?

Loss of independence --> Can lead to depression.

29

Depression may predispose a person to develop ...?

CHRONIC PAIN - More commonly, chronic pain results in DEPRESSION.

30

People who experience pain after a procedure have a ...?

Higher risk of morbidity and mortality + A slower recovery from procedure.

31

Managing chronic pain - Pain relief in pain caused by PHYSICAL illness is best achieved by ...?

Analgesics (eg opioids), using PATIENT-CONTROLLED ANALGESIA (PCA), or nerve-blocking surgical procedures.

32

Managing pain - Antidepressants:

Particulalry TCAs = Useful.

33

Antidepressants are most useful for patients with:

1. Arthritis.
2. Facial pain.
3. Headache.

34

Antidepressants - Their analgesic effect may be the result of:

Stimulation of efferent inhibitory pain pathways.

35

Many patients with chronic pain are UNDERMEDIATED because ...?

The physician fears that the patient will become addicted to opioids.
HOWEVER --> Most patients with chronic pain EASILY DISCONTINUE THE OPIOIDS as the pain remits.

36

Stress and health - Psychological factors affecting health - Psychological factors that may affect medical disorders:

1. Poor health behavior (eg smoking, failure to exercise).
2. Maladaptive personality style (eg obsessive-compulsive personality).
3. Chronic or acute life stress caused by emotional (eg depression), social (eg divorce), or economic (eg job loss) difficulties.