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Y4 Psychiatry > 14 - Liaison Psychiatry > Flashcards

14 - Liaison Psychiatry Flashcards

1
Q

What is Liaison psychiatry?

A

Liaison psychiatrists provide psychiatric care to medical patients (taking physical and mental health together)

They attend emergency departments, general hospital in and out patients, and primary care medical service

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2
Q

What are some conditions that liaison psychiatrists might look at?

A
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3
Q

What psychiatric disorders can steroid treatment precipitate?

A

When the dose of steroids is high

  • STEROID INDUCED MANIA
  • Psychosis
  • Affective disorders e.g depression, bipolar
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4
Q

What may be more suggestive of pseudoseizures (or dissociative seizures) on both history and examination than seizures?

A
  • Asynchronous limb movements – often bizarre
  • Resisting attempts to open eyes
  • Protective/avoidance behaviour – i.e. patient doesn’t sustain injuries
  • Emotional trigger for event e.g. happens during argument.
  • No post-ictal period (generalised seizure often lengthy recovery)
  • Patient able to recall what happened during the actual seizure
  • Tongue biting and incontinence very rare
  • Prolonged seizure >3 mins
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5
Q

What test can you do to distinguish a pseudo seizure from a seizure?

A
  • Prolactin – this is not diagnostic of a seizure, however prolactin is often released during a seizure and therefore higher levels are detected in the first 2 hours post-seizure. This would not be the case in pseudoseizures.
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6
Q

What are factitious symptoms? (Munchausen’s)

A

A patient will feign symptoms but with no clear secondary gain other than to achieve the sick role and therefore care.

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7
Q
A

Post Partum Psychosis but need to rule out delirium

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8
Q

What is important to note in the history of a woman who may be experiencing postpartum psychosis?

A
  • Past history of postpartum psychosis
  • Past history of Bipolar affective disorder or Schizoaffective disorder
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9
Q

How is steroid induced mania treated?

A
  • Treat as for any other mania – usually antipsychotic first-line
  • Liaise with oncology team risk/benefit of continuing steroid and whether to gradually reduce
  • Long term psychiatric follow up in outpatients, gradual reduction of antipsychotic
  • Psychoeducation re. relapse indicators of future mood episodes for both patient and family
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10
Q

What is the definition of the following:

  • Somatoform disorders
  • Dissociative (conversion) disorders
A

Somatoform disorders

Symptoms are suggestive of a physical disorder but in the absence of a physiological illness leading to the presumption that they are caused by psychological factors. Sufferers repeatedly seek medical attention

Dissociative (conversion) disorders

Symptoms which cannot be explained by a medical disorder and where there are convincing associations in time between symptoms and stressful events. Unpleasant stressful events are ‘converted’ into symptoms

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11
Q

What is the prevalence of somatoform disorders and what are some risk factors for this?

A

0.1 to 2%

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12
Q

What are some different types of somatoform disorders?

A
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13
Q

What is the ICD10 criteria for somatisation disorder?

A

Multiple recurrent frequently changing physical symptoms not explained by a physical illness

Often dependent on analgesics with some form of functional impairment

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14
Q

What is hypochondriacal disorder?

A

Patient misinterprets normal bodily sensations which leads them to develop non-delusional preoccupations that they have a serious physical disease e.g cancer

They refuse to accept reassurance from doctors

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15
Q

How are Somatoform disorders diagnosed?

A

Diagnosis of exclusion

Multiple vague symptoms occurring in different organ systems

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16
Q

What is Malingering?

A

Patients intentionally fake or induce illness for secondary gain; e.g. drug seeking, disability benefits, avoiding work or prison time

17
Q

How are somatoform and dissociative disorders managed?

A

Biological: SSRIs for any underlying mood disorders

Psychological: CBT, Coping strategies

Social: Involve family members who reinforce the sick role

18
Q

What are the common causes of acute confusional state?

(important card to go over)

A
  • Delirium
  • Psychosis
19
Q

What is the difference between conversion disorder and somatosisation disorder?

A

Conversion is usually neurological (motor or sensory symptoms)

Somatosisation is usually physical/physiological

20
Q

What is baby blues and how many women does it affect?

A

Affect more than 50% of women in the first week or so after birth

  • Mood swings
  • Low mood
  • Anxiety
  • Irritability
  • Tearfulness

Symptoms are usually mild, only last a few days and resolve within two weeks of delivery. No treatment is required.

21
Q

What is post natal depression and what is the prevalence of this?

A

1 in 10 women, peak incidence at 3 months post birth

Two weeks symptoms of:

  • Low mood
  • Anhedonia (lack of pleasure in activities)
  • Low energy
22
Q

What are some risk factors for postpartum depression?

A
  • History of postpartum depression (50%)
  • Unipolar/ bipolar depression (25%)
  • Unplanned pregnancy
  • Lack of support
  • Marital problems
  • Social circumstances
23
Q

How is post partum depression treated?

A

Need to treat as can affect infants cognitive and social skills

  • Mild: additional support, self-help and follow up with their GP
  • Moderate: antidepressants and CBT
  • Severe: may need input from specialist psychiatry services
24
Q

What antidepressant should you not use for post partum depression?

A

Fluoxetine as high doses in breast milk

Can use other SSRIs and TCAs

25
Q

What tool can be useful to measure post natal depression?

A
  • Edinburgh Postnatal Depression Scale
  • PHQ9
26
Q

What is the epidemiology of post partum psychosis?

A

1 in 1000 women (0.1-0.2%)

Peak onset at 2-3 weeks post birth

27
Q

What are some of the presenting features of post partum psychosis?

A
  • Delusions that are mood-congruent
  • Hallucinations
  • Depression
  • Mania
  • Confusion
  • Thought disorder
28
Q

What are some of the risk factors for puerperal psychosis?

A
  • Previous postpartum psychosis has 30% recurrence risk
  • Previous postpartum depression
  • Single parenthood
  • Reduced social support
  • Previous mental illness

Prevent by having individualised care plan for high-risk individuals

29
Q

How is postpartum psychosis treated?

A

EMERGENCY ASSESSMENT

  • Admission to the mother and baby unit
  • CBT
  • Medications (antidepressants, antipsychotics or mood stabilisers)
  • Electroconvulsive therapy (ECT)
  • Social support

Y4 Psychiatry (17 decks)

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