1b Psychiatry intro

Question 1

what is an adjustment reaction?

Answer 1

• states of subjective distress and emotional disturbance
• interfering with social functioning/performance
• arising in a period of adaptation to a significant life change or stressful life event

Question 2

what is an organic delusional disorder?

Answer 2

a disorder in which persistent or recurrent delusions dominate. there may be hallucinations, thought disorders too

Question 3

what is the prevalence of post stroke psychosis?

Answer 3

delusions 4.7%
hallucinations 5.1%
more common in right hemisphere strokes (5:1)

Question 4

what is post stroke psychosis?

Answer 4

psychosis following a stroke

common delusional themes: persecutory, jealousy, environmental

Question 5

what is the point prevalence of mental illness in england?

Answer 5

20%

Question 6

what is a significant risk factor for mental illness?

Answer 6

having a long term physical condition

Question 7

what is the morbidity rate of mental illness?

Answer 7

takes 20 years off life expectancy

Question 8

what is the MoCA?

Answer 8

montreal cognitive examination

highly sensitive

Question 9

what are the types of delirium?

Answer 9

hypoactive - depressed, withdrawn and subdued

hyperactive - aggressive, loud presentation

Question 10

what is delirium?

Answer 10

psychiatric manifestation of physical illness

Question 11

what is the range of delirium causes?

Answer 11

very large - change in environment, surgery, medications, constipation, hypoxia etc

Question 12

what are the predisposing factors to delirium (9)?

Answer 12

advanced age, dementia, impaired AoDL (activities of daily living), immobility, sensory impairment, urinary catheterisation, malnutrition, alcohol, depression

Question 13

how does one manage delirium?

Answer 13

anticipate, modify risk factors & early diagnosis
treat the cause, good nursing, medication (often not helpful), wait it out

Question 14

what is mental health stigma?

Answer 14

challenges faced by mentally ill people related to: poor understanding, negative attitudes towards mental illness, social exclusion

Question 15

what is intrapersonal stigma?

Answer 15

internalised discrimination compounded by the direct effects of the illness

Question 16

what is interpersonal stigma?

Answer 16

stigma from friends, family, colleagues which may cause social isolation

Question 17

what is structural stigma?

Answer 17

poor resources/funding and access to physical health care compounding social stigma

Question 18

give examples of illnesses causing mental deficits

Answer 18

thyrotoxicosis - mania, anxiety
hypothyroidism - depression, dementia
cushings - depression
infections - depression
cancer - depression
parkinsons - depression, anxiety, dementia

Question 19

Outline the prevelance of delirium (5).

Answer 19

• 20% of acute hospital patients > 65 have delirium on admission
• 30% of patients on wards have delirium
• 80% of patients in intense care have delirium
• 50% of delirium patients are hypoactive
• 50% of delirium patients go undetected

Question 20

What are the causes of delirium (14)?

Answer 20

• P - Pain
• I - Infection (urine / pneumonia / cellulitis / wound etc.)
• N - Nutrition (Hyponatraemia)
• C - Constipation
• H - Hydration/ Hypoxia
• E - Endocrine + Electrolyte (urine detection), Encephalitis
• S - Stroke/ surgery
• M - medication (opiates / anticholinergics / steroids) and Alcohol withdrawal
• E - Environmental changes (ITU / HDU / ward)

+ Liver / Renal impairement

Question 21

What are the causes of stigma (3)?

Answer 21

• Poor understanding of mental health
• Negative attitude
• Social exclusion

Question 22

What are the 3 types of stigma?

Answer 22

• Intrapersonal stigma
• Interpersonal stigma
• Structural stigma

Question 23

What is delirium?

Answer 23

• Organic syndrome characterised by concurrent disturbances of consciousness and attention, perception, thinking, memory, psychomotor behaviour, emotion and the sleep-wake schedule
• The duration is variable and the degree of severity ranges from mild to very severe