4- Liason/ Physical conditions Flashcards
What is liaison psychiatry?
Psychiatry (mental health) as applied to medical hospitals (medically unwell) e.g.
- Self-harm/suicide (a and e)
- Medically unexplained symptoms (MUS)
- Delirium/dementia
liason psychiatry links
Relationship between mental and physical health
Physical health problems significantly increase the risk of poor mental health, and vice versa. Around 30 per cent of all people with a long-term physical health condition also have a mental health problem, most commonly depression/anxiety
types of medically unexplained symptoms (MUS)
1) Somatization
- Multiple physical complaints, no medical explanation – Common
2) Conversion Disorder
– Single physical complaint, a psychological explanation – Rare
3) Malingering
- Pretending to be ill in order to escape duty
MUS model
examples of MUS in hospitals vs gp
Main MUS syndromes
- Somatization disorder (8 symptoms)
- Conversion disorder (1 symptom)
- Hypochondriasis
- Factious disorder
- Body dysmorphic disorder
- ? Pain disorder
somatization disorder
> 8 symptoms
- common
- diagnosed when a person has a significant focus on physical symptoms, such as pain, weakness or shortness of breath, to a level that results in major distress and/or problems functioning. The individual has excessive thoughts, feelings and behaviors relating to the physical symptoms.
conversion disorder
- 1 symptom
- less common
- features nervous system (neurological) symptoms that can’t be explained by a neurological disease or other medical condition. However, the symptoms are real and cause significant distress or problems functioning.
hypochondriasis
worrying excessively that you are or may become seriously ill. You may have no physical symptoms.19 Apr 2021
management of MUS
- Therapeutic alliance
- Clarify main complaint
- Liaise re normal investigations
- Rationalise extraordinary investigations
- Clarify psychiatric comorbidity
- Clarify external stress
- CBT & behavioural model of coping
- Support groups & peer support
summary of organic affective disorders
It describes reduced brain function due to illnesses that are not psychiatric in nature.
Key symptoms
- anger-irritability
- apathy
- mania
- anxiety
- depression
Key causes
1) Neurological
- CNS tumous
- Head injiry
- huntingtons choea
- stroke
- Creutzfelt -jakob disease
- encephalitis
- parkinsons
- MS
- dementia e.g. Alz, frontotemporal
- Neurosyphilis
2) General medical
- AIDs and other infections
- Wilsons disease
- Rabies
- hypoglycaemia
- phaeochromocytoma
- hyper/hypothyroidism
- anaemia
- cancer
- IBD/IBS
- iscaemica heart disease
- RA
- cushings/ addisons
- DM
- hyperprolactinamia
3) Drugs
- illicit drugs
- alcohol
- alcohol withdrawal
organic causes of anger
-alcohol
- dementia
- frontal love tumour
- head injiry
- huntingtons
-
organic cause sof mania
- CNS tumour
- head injury
- Huntingotns
- MS
organic causes of anxiety
- head injury
- MS
- neurospyhilis
- parinksons
- wilsons disease
- CVS disease
- hypethyroidism
- hypoglycameia
- rabies
- alcohol withdrawal
- barbituate withdrawal
- benzo withdrawal
- caffeine
- illicit drugs
- SSRI acclimatisation
- thyroine
drug induced psychosis
prominent hallucinations (type I)
include visual and non-visual hallucinations
delusions and hallucinations (type II and III)
psychosis in:
- delirium (II)
- dementia (III)
prominent delusions (type IV)
splkit into
- affective psychosis
- schizoprheniform psychosis
summary of organic causes of organic impairment
split into:
1) Global deficits
2) Focal deficits
global deficits of cognitive impairment
split into
1) Acute
- Delirium
2) Subacute
- Delirium
- Pseudo or reversible dementia
3)Gradual
- Dementia
causdes of focal deficits in cognitive impairment
