CL Flashcards
% of admitted pt with psych conditions
% of chronically medically ill with psych conditions
@ patients with depression
psych consults
30-60% have psychosicial or psych morbidity
40%
10-14%
1%
b12 def
i. dementia, psychosis, mania, and mood disorders can all be symptoms of B12 deficiency
ii. reflexes are generally depressed, but can be hyper
iii. pallor, dizziness, peripheral neuropathy, dorsal column signs, fatigue, ataxia, irritability, inattentiveness, loss of appetite, diarrhea, numbness and tingling of hands and feet, shortness of breath, weakness, sore mouth and tongue, confusion or change in mental status in severe or advanced cases, physical evaluation of the patient’s neurological signs may show depressed deep tendon reflexes, decreased position sense, decreased vibration sense, or positive Babinski reflex.
giving folate if B 12 deficient can worsen neuro sx
most common psych sx in hyperparathyroidism? SLE? Cushing? renal failure? wilsons? stroke?
Depression
neuropsych sx in MS
MCI: 30-50% serious cognitive imparement in 20-30% depression 25-50% euphoria 25% personalty change irritabilty apathy 20-40%
note: language largely spared
porphyria
- Autosomal dominant metabolic disirder
- Problem in heme production
- Second most common porphyria (1st is cutanea tarda)
- 95% of people have abdominal pain-intermittent.
- Urinary symptoms (dysuria, dark urine)
- Peripheral neuropathy
- Proximal motor weakness
- Sympathetic nervous symptoms (circulating catecholamines are increased)
- Hyponatremia can occur due to SIADH
labs: urinary porphobilinogen high\urinary delta aminolevulinic acid high
rinary porphyrin high
interferon
Significant depressive symptoms occur in 21-58% of patients receiving IFNα, with symptoms typically manifesting over the first several months of treatment.
The most replicated risk factor for developing depression is the presence of mood and anxiety symptoms prior to treatment.
Other potential, but less frequently replicated, risk factors include a past history of major depression, being female and increasing IFNα dosage and treatment duration
symptoms may decrease with time
SIADH
low specific gravity of urine and low sodium concentration
Treatment for water intoxication includes:
• restricting water intake
• minimizing drugs that cause dry mouth
• frequent weighing to monitor for water retention
not used to lose wt or prevent weight gain
prozac,verapamil used as per MCQ: nizatadine b. amantadine c. topiramate d. metformin
HIV
1 dx: adjustment DO 10-20%
previous mood, substance DO or NCD predct depression
in frank aids: 40% may meet criteria for MDD
mania is rare, same as gen pop except late in illness ay go up 10 time (variable) if NCD
RF for Torsade de point
female sex • hypokalemia • congestive heart failure • high doses of offending agent • sub-clinical long QT syndrome • long-QT interval in baseline electrocardiogram fam hx of congenital deafness
chronic fatigue and depression
Up to 80% meet criteria for MDE, but rarely report feelings of guilt, SI, anhedonia, and little
or no weight loss. Usually no family hx of depression
RR of getting theseillnesses 2ry to depression
CVD Stroke eplepsy alz dm cancer
CVD 2 fold stroke 2fold epilepsy 5 fold Alz 2 DM 60% cancer 2?
RR of mortality with depression (depression worsens outcome)
CVD
sroke
cancer
CVD 4 fold
stroke 3 fold (or by 10%)
cancer 2 fold
therapy for medical illness with depression
education
transition/loss
CBT post MI
IPT, problem solving post stroke
phaeo sx
Test
headach, sweating , tachy is the triad
also HTN
panic attacks in 40%
Test: best is plasma metanephreins supine
can do VMA in urine, 24 hour urinary fractioned metanephrines
