Approach to Psychosomatic Disorders Flashcards
What are the two basic assumptions in Psychosomatic medicine ?
- unit of mind and body
- psychological factors must be considered in all disease states
a holistic approach to medicine!
what is psychosomatic medicine?
a medical condition separate from a mental disorder that is present
mental/psychological factors adversely affect general medical conditions
what is an independent risk factor for coronary heart disease, is associated with increased risk of subsequent stroke and diabetic symptoms
depression
what mood disorder is a risk factor for asthma, coronary artery disease, and specific phobias
anxiety
what mood disorder impaired presentation and treatment of symptoms of a plethora of health conditions
schizophrenia
what disorder can cause maladaptive health behaviors like over eating, unsafe sex or be in denial of the need for surgery even with cancer
personality disorders
what is stress
a circumstance that disturbs or is likely to disturb normal physiological/psychological functioning of a person
describe the stress theory: what is set into motion first
the sympathetic nervous system increases, heart rate, blood pressure, and cardiac output
how does the body respond to stress
neurotransmitters:
endocrine response:
immune response:
life events:
tries to maintain homeostasis
neurotransmitters: release catecholamines, increase serotonin, increase steroids, increase dopamine
endocrine response: increase ACTH, promotes energy
immune response: inhibited
life events: increased chance of mental illnesses
medical symptoms of lupus
psychiatric symptoms of lupus
medical: photosensitivity, butterfly rash, joint pain, fever
psych: depression, mood disturbances, psychosis, delusions
medical symptoms of MS:
psychiatric symptoms of MS:
medical: motor and sensory disturbances, impaired vision (optic neuritis) ,remissions and exacerbations, slurred speech
psych: anxiety, euphoria, mania
medical symptoms of seizure
psychiatric symptoms of seizure:
medical: sensory distortions, delirium, memory loss
psychiatric symptoms: confusion, psychosis, dissociative states, belligerence, catatonic like state
_ can cause CAD/MI and CAD/MI can cause _
depression
depression
30% of asthmatics meet criteria for _
agoraphobia/panic disorder
fear of dyspnea can trigger asthma attacks and anxiety
anxiety disorder and panic disorder have a high level in what chronic respiratory disease
COPD
hyperthyroidism medical symptoms
hyperthyroidism psychiatric symptoms
medical symptoms: heat intolerance, excessive sweating, diarrhea, weight loss, tachycardia, palpitations, vomiting, tremor , short attention span. bulging eyes
psy: nervousness, excitability, irritability, psychosis, visual hallucinations, insomnia
hypothyroidism medical symptoms
hypothyroidism psychiatric symptoms
medical: cold intolerance, dry skin, constipation, weight gain
psych: leathery, depressed, personality change, paranoia
medical and psych symptoms of diabetes
medical: increased urination/thirst, glucose is high
psych: depression
pheochromocytoma medical and psych symptoms
medical: paroxysmal hypertension, headaches, sweating, tremor
psych: anxiety, apprehension, feeling of impeding doom, panic
hyponatermia medical and psych symptoms:
medical: excessive thirst, polydipsia, stupor, coma, seizures
psych: confusion, lethargy, personality changes
thiamine def medical and psychiatric symptoms
medical: neuropathy, cardiomyopathy, wernicke syndrome
psych: poor concentration, confusion, confabulation
cobalamin vitamin B12 def medical and psych symptoms
medical: pallor, dizziness, peripheral neuropathy, dorsal column signs, (if levels less than 400)
psych: irritability, inattentiveness, psychosis, dementia
copper can cause
psychosis
vitamin A and D, and iron can all cause
confusion
B6 and B12 affect
peripheral nerve function
lead can cause
cognitive dysfunction
Peptic ulcer disease leads to increase _ _ excretion which can be associated with psychological stress
gastric acid
ulcerative colitis shows increased prevalence of
dependent personality disorders
churns disease has high rates of preexisting
panic disorder
some of the most common side effects of antidepressants are
gi disturbances; nausea and diarrhea
TCA side effects
constipation and dry mouth
medical symptoms and psychiatric symptoms of acute intermittent porphyria
medical: abdominal pain, consitpation, peripheral neuropathy, paralysis
psych: acute depression, agitation, paranoia
medial symptoms and psych symptoms of hepatic encephalopathy
medical: asterisks, spider angioma, polar erythema, lover enlargement, ecchymosis
psy: supporta, disinhibition, psychosis, depression
psoriatic episodes are related to _ events
stressful
medical symptoms of brain neoplasms
psych symptoms
medical: headache, papilledema, vomiting, focal neurological deficit
psych: personality changes depending on location
frontal lobe tumor causes changes in what
mood, irritability, judgement, speech, smell, memory
occipital lobe tumors present with
visual hallucinations and aura
head trauma medical and psych symptoms
medical: headache, bleeding from ear, altered LOC, neurological findings (location based as well)
psych: confusion, personality changes, memory problems, agitation
PCP intoxication
medical symptoms
psych symptoms
medical: elevated BP, vertical and horizontal nystagmus, muscular rigidity, vomiting
psych: agitation with a blank stare, anxiety, stupor, aggression, panic, bizarre strength (pick up car?)
cocaine/amphetamine inoxication
medical symptoms:
psych symptoms:
medical: elevated BP, tachycardia, dilated pupils, sweating, tremor
psych: agitation with delusions, euphoria with irritability
LSD intoxication
medical symptoms
psych symptoms
medical : sympathetic overdrive
psychL sensory distortion, hypersensitivity of senses, hallucinations
the study, practice, and teaching of the relationship between medical and psychiatric disorders
psychiatrists serve as consultants in hospital settings to bridge between psychiatry and other specialties
consultation liaison
what are some common reasons a consultation liaison would be used
suicide attempt/threat
depression
agitation
hallucinations
sleep disorder
confusion
_ is the most common cause of hallucinations
delirium tremens
_ is the most common cause of confusion or disorientation among hospitalized patients
delirium
delirium is common in what population
elderly, ICU patients
educate pt and family about this proper to hospitalization
reversible acute onset of impaired cognition , attention, consciousness, perception, sleep patterns (day vs. night) , and emotional states that fluctuate
delirium
what are some interventions we can use to mitigate delirium
orientation protocols with the use of clocks and calendars
cognitive stimulation ( vitas from friends/family during the day)
facilitate psychologic sleep (avoid at night)
avoid _ (medication) in elderly hospialized patients
benzodiazepines
1.One or more somatic symptoms that are distressing or result in significant disruption of daily life.
2.Excessive thoughts, feelings, or behaviors related to the somatic symptoms or associated health concerns as manifested by at least one of the following:
1. Disproportionate and persistent thoughts about the seriousness of one’s symptoms. 2. Persistently high level of anxiety about health or symptoms.
3. Excessive time and energy devoted to these symptoms or health concerns.
3.Although any one somatic symptom may not be continuously present, the state of being symptomatic is persistent (typically more than 6 months).
somatoform disorder (pain disorder)
-somatic symptom disorder
how do we treat somatoform disorder
have a good relationship with the patient
have a team approach
CBT
anti anxiety medications
conversion disorder
following times of high stress neurological voluntary motor or sensory problems arise
symptoms of conversion disorders
- Paresthesias and anesthesias
- Weakness
- Paralysis
*Pseudoseizures/psychogenicseizures - Involuntary movements (e.g. tremors, tics)
- Sensory disturbances * Blindness
- Mutism
illness anxiety disorder
hypochondriac (ME) fear of something being medically wrong for no reason essentially
or I have a cold, and think I have cancer (out of proportion)
factitious disorders
intention fabrication of medical symptoms not for secondary gain
munchausens
factious disorder where you are giving yourself medical symptoms
vs
proxy- giving medical conditions to someone else
malingering
intention fabrication of medical symptoms with evidence of secondary gain ( fabricating symptoms to get disability approved)
