1b Mental Disorders and Physical Health

Question 1

What is the most common cause of post stroke psychosis?

Answer 1

Right sided middle cerebral artery lesions affecting the frontal and temporal regions

Question 2

What are the most common reported symptoms of post stroke psychosis?

Answer 2

Delusions - generally of the persecutory or jealous type

Question 3

What are the most common perceptual abnormalities of a post stroke psychosis?

Answer 3

Auditory hallucinations followed by visual

Question 4

What is the managemnet for post stroke psychosis?

Answer 4

No treatment but antipsychotics have been seen to help. However antipsychotics increases risk of stroke in patients with dementia

Question 5

What are some multifactory causes of chronic mental illness?

Answer 5

Medication adverse effects (e.g. weight gain, dyslipidaemia, insulin insensitivity, hypertension, sedation)
Increased rates of smoking, illicit substance use and alcohol intake
Poor diet and exercise
Chaotic lifestyles and low socioeconomic status

Question 6

What are some management options for people with physical health problems and mental illnessto mitigate any adverse effects on mental health?

Answer 6

Choose medication that minimises impact on physical health
E.g. weight gain sparing antidepressants and antipsychotics in those already with increased BMI
Monitoring of cardiometabolic factors (BMI, HbA1C, lipid profile, blood pressure)
Smoking cessation
Dietary advice
Drug and alcohol support services

Question 7

What factors affect the timely diagnosis of physical disorders in people with mental disorders?

Answer 7

Illness behaviour
Diagnostic overshadowing
Stigma
Lack of resources/access

Question 8

What is diagnostic overshadowing?

Answer 8

misattribution of physical symptoms to psychiatric symptoms

Question 9

What is delirium?

Answer 9

Delirium is characterized by a disturbance of attention, orientation, and awareness that develops within a short period of time, typically presenting as significant confusion or global neurocognitive impairment, with transient symptoms that may fluctuate depending on the underlying causal condition or etiology

Question 10

What are the four types of hallucinations?

Answer 10

Visual hallucinations (most common type in delirium)
Auditory hallucinations
Gustatory or olfactory hallucinations
Tactile hallucinations

Question 11

What is delirium an example of?

Answer 11

the psychiatric manifestation of physical disease

Question 12

how is delirium broadly classified?

Answer 12

Hyperactive – Agitation, hallucinations, inappropriate behaviour
Hypoactive – Lethargy, reduced concentration, reduced alertness, reduced oral intake
Mixed – A combination of the above

Question 13

What are some risk factors for delirium?

Answer 13

Advancing age
Cognitive impairment (e.g. dementia), sensory impairment
Poor nutrition
Polypharmacy/alcohol misuse
Frailty

Question 14

How does a critical illness lead to delirium?

Answer 14

A critical illness leads to increased cortisol and cerebral hypoxia ( older adults predisposed) which leads to↓acetylcholine synthesis and dysfunctions of hippocampal and neocortical areas

Question 15

How is delirium managed?

Answer 15

• Anticipate
• Modify risk factors if possible
• Early diagnosis
• Treat the causes
  Reorientation strategies
  Normalise sleep wake cycles
  maintain safe mobility to avoid falls

Question 16

What are some re-orientation strategies?

Answer 16

familiar environments, use of clocks, reminding of name and current location

Question 17

What should be done about challenging behaviour in delirium?

Answer 17

Address underlying unmet needs (thirst, need for toilet, discomfort/pain)
Safe and low stimulation environments
Verbal and non-verbal de-escalation techniques
In extremis – Short term pharmacological interventions (e.g. low dose Haloperidol [0.5mg] for <7 days)

Question 18

What are the most common causes of delirum?

Answer 18

> constipation
urine retention
dehydration