Psychosomatic medicine

Question 1

psychological factors affecting medical conditions

Answer 1

• mental disorder
• psychological sx’s
• personality traits or coping style
• maladaptive health behaviors
• stress-related physiological response
• other psychological factors

Question 2

Stress theory

Answer 2

• a circumstance that disturbs the normal physiological or psychological fxning of a person
• stim of SNS- tachycardia, HTN, inc CO- stress!!

Question 3

Responses to stress

Answer 3

• inc serotonin turnover

- inhibition of immune fxning

Question 4

Musculoskeletal system- what presents w psychiatric illness/sx’s?

Answer 4

• SLE
• MS
• seizure disorder

Question 5

SLE

Answer 5

• fever, photosensitivity, butterfly rash, joint pains, HA

- depression, psychosis, delusions, halucinations

Question 6

MS

Answer 6

• motor/sensory disturbances..etc

- anxiety, euphoria, mania

Question 7

seziure disorder

Answer 7

-confusion, psychosis, dissociative states, catatonic like state, bizzare behavior

Question 8

CV system- affected by? affected how?

Answer 8

• depression, anxiety, type A behavior, acute mental stress- risk for coronary dz!!!
• cardiac arrhythmias and sudden cardiac death
• HTN
• heart transplantation response

Question 9

Resp system- what presents w psychiatric illness/sx’s?

Answer 9

• Asthma

- COPD

Question 10

Asthma

Answer 10

-30% have panic disorder!!

Fear of dyspnea can trigger anxiety

Question 11

COPD

Answer 11

-anxiety disorder, panic disorder

Question 12

Endocrine system- what presents w psychiatric illness/sx’s?

Answer 12

• Hyperthyroidism
• hypothyroidism
• diabetes mellitus
• hyponatremia
• vit def- thiamine (B1), B12

Question 13

Hyperthyroidism

Answer 13

-nervousness, excitability, irritability, pressured speech, insomnia, psychosis, visual hallucinations
(anxiety)

Question 14

Hypothyroidism

Answer 14

-lethargy, depressed, personality change, paranoia

depression

Question 15

diabetes mellitus

Answer 15

depression!!!!

Question 16

hyponatremia

Answer 16

-confusion, lethargy, personality changes

Question 17

Thiamine def

Answer 17

(in alcoholics)

-poor concentration, confusion, confabulation (cant remember things!!)

Question 18

cobalamin (vit B12) def

Answer 18

-irritability, inattentiveness

Question 19

GI- what presents w psychiatric illness/sx’s?

Answer 19

• peptic ulcer dz
• UC
• CD

Question 20

peptic ulcer dz

Answer 20

-assoc w stress

Question 21

ulcerative coliits

Answer 21

-inc prevalence of dependent personalities

Question 22

crohn’s dz

Answer 22

-high rates of panic disorder

Question 23

GI- drug SE’s

Answer 23

Antidepressants!!!

• SSRIs- nausea, diarrhea
• TCAs- anticholinergic effects- constipation, dry mouth

Question 24

Hepatic/Pancreatic system- what presents w psychiatric illness/sx’s?

Answer 24

• pancreatic carcinoma
• acute intermittent porphyria
• hepatic encephalopathy

Question 25

Pancreatic carcinoma

Answer 25

-depression!!!

Question 26

acute intermittent porphyria

Answer 26

abd pain + psychosis!

Question 27

Skin- what presents w psychiatric illness/sx's?

Answer 27

- atopic dermatitis - psoriasis - urticaria

Question 28

atopic dermatitis

Answer 28

-anxiety, depression

Question 29

psoriasis

Answer 29

-anxiety, depression

Question 30

Tumors- what presents w psychiatric illness/sx's?

Answer 30

- brain neoplasms - frontal lobe tumor - occipital lobe tumor

Question 31

brain neoplasms

Answer 31

-personality changes!

Question 32

frontal lobe tumor

Answer 32

-mood changes, irritability, facetiousness, impaired judgement, impaired memory, delirium, loss of speech, loss of smell

Question 33

occipital lobe tumor

Answer 33

-aura, visual hallucinations

Question 34

Head trauma- sx's

Answer 34

-confusion, personality changes, memory impairment | aggressive, impulsive

Question 35

Treatments- stress management

Answer 35

- self-observation (diary- stressors) - cognitive restructuring - relaxation exercises - hypnosis

Question 36

Consultation-liason psychiatry

Answer 36

-relation b/w medical and psychiatric disorders

Question 37

Common consultation-liason problems

Answer 37

- suicide attempt/threat- risk factors: men, >45yo, no social support, alcohol dependence, prev suicide attempt, incapacitating medical illness - depression - agitation- dementia (#2!) - hallucinations- DT is most common cause! - sleep disorder - confusion- delirium is most common cause! (#!)

Question 38

delirium

Answer 38

- in elderly, surgical, ICU pts - educate pt and family PRIOR to hospitalization/surgery!! - reversible, acute onset of impaired cognition, attention, consciousness, perception, sleep patterns that fluctuate over course of day

Question 39

Delirium- interventions to mitigate risk factors

Answer 39

-orientation protocols (use of clocks, calendars, windows) -cognitive stimulation -facilitate physio sleep AVOID BENZODIAZEPINES IN ELDERLY HOSPITALIZED PTS (makes them more confuseD)

Question 40

Substance-induced mental disorders

Answer 40

- PCP - amphetamine/cocaine - LSD - corticosteroids - benzodiazepines - anti-parksinson's meds - antidepressants

Question 41

PCP

Answer 41

- elevated BP, tachycardia, nystagmus, muscular rigidity, vomiting - agitation w blank stare, anxiety, stupor, aggression, panic, bizarre behavior

Question 42

Amphetamine/cocaine

Answer 42

- inc BP, tachycardia, mydriasis, diaphoresis, tremor | - agitation, delusions, euphoria

Question 43

LSD

Answer 43

- sympathetic excess | - hallucinations!!

Question 44

corticosteroids

Answer 44

-mania, psychosis (hallucinations!!)

Question 45

benzodiazepines

Answer 45

-avoid use in elderly w delirium!!!!

Question 46

antidepressants

Answer 46

- mania (in bipolar pts) | - insomnia