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Neuromusculoskeletal & Psychiatry I Exam #1 > Clinical Approach to Psychosomatic Disorders > Flashcards

Clinical Approach to Psychosomatic Disorders Flashcards

1
Q

Psychosomatic medicine has 2 major assumptions. What are they?

A
  1. Unity of mind and body.

2. Psychological factors must be considered in all disease states.

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2
Q

Use Mood Disorder as a example of psychosomatic disorder

A

Mood disorder

  • Depression: independent risk factor for coronary heart disease.
  • > poor outcomes for CHD
  • > recurrent coronary events
  • > impaired functioning
  • > poorer quality of life
  • > increased mortality
  • associated with increased risk of stroke
  • a number of depressive symptoms are related to the number of diabetic symptoms.
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3
Q

What medical risks are associated with Mood Disorders: Anxiety?

A

Coronary heart disease
Asthma
Specific phobias

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4
Q

What medical risks are associated with personality traits or coping style?

A

Pathological denial of need for surgery in patients with cancer.

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5
Q

What medical risks are associated with maladaptive coping behaviors?

A

Overeating
Lack of exercise
Unsafe sex practices

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6
Q

What is Stress Theory?

A

Stress: a circumstance that disturbs, or is likely to disturb, the normal physiological or psychological functioning of a person.

Stimulation of autonomic nervous system, particularly the sympathetic nervous system:
->Tachycardia, Hypertension, Increased CO, which results in more stress.

Body puts into motion a set of responses that seeks to diminish the impact of the stressor and restore homeostasis.

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7
Q

What are the NT responses to stress? (4)

A

+ NE systems: release catecholamines

+ Serotonin systems: increased serotonin turnover

Glucocorticoids enhance serotonin function

Increased DA neurotransmission

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8
Q

What are the endocrine responses to stress?

A

+ Corticotropin-releasing factor: CRF (hypothalamus) triggers release of ACTH.
-> promotes energy use, increased CV activity and inhibiting growth, reproduction and immunity.

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9
Q

How are life events “measured”?

A

Social readjustment scale

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10
Q

What disorders of the MSK system are effected by stress? (3)

A
  1. SLE
    - medical symptoms: fever, photosensitivity, butterfly rash, arthralgias, HA.
    - psychiatric symptoms: depression, mood changes, psychosis, etc.
    * treated with supportive psychotherapy.
  2. Multiple Sclerosis
    - medical symptoms: transient motor/sensory disturbances, impaired vision, diffuse neurological signs with remissions and exacerbations, slurred speech, incontinence.
    - psychiatric symptoms: anxiety, euphoria, mania.
  3. Seizure Disorder
    - medical symptoms: sensory distortions, violence, belligerence.
    - psychiatric symptoms: confusion, psychosis, dissociative states, catatoniclike state, bizarre behavior.
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11
Q

What disorders of the CVS are effected by stress? (4)

A
  1. Coronary heart disease - 2-fold increased risk for MI and CAD-related mortality.
  2. Arrhythmias and sudden cardiac death - autonomic cardiac modulation is sensitive to acute emotional stress.
  3. HTN
  4. Heart transplantation
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12
Q

What disorders of the respiratory system are effected by stress? (2)

A
  1. Asthma - 30% meet criteria for panic disorder or agoraphobia. Fear of attach can trigger anxiety.
  2. COPD
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13
Q

What disorders of the endocrine system are effected by stress? (4)

A
  1. Hyperthyroidism
  2. Hypothyroidism
  3. DM - depression**
  4. Pheochromocytoma
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14
Q

What disorders of the metabolic system are effected by stress? (3)

A
  1. Hyponatremia
  2. Vitamin deficiencies
    - Thiamine deficiency: confabulation, confusion, poor concentration.
    - Cobalamin (vit. B12) deficiency
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15
Q

What are the psychiatric effects of the following toxicities:

Vitamins A, D and Iron

Cu

Vitamins B6 and B12

Lead

A

Vitamins A, D and Iron: confusion

Cu: psychosis

Vitamins B6 and B12: peripheral nerve function

Lead: cognitive dysfunction

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16
Q

What disorders of the GI system are effected by stress? (3)

A
  1. PUD: increased acid secretions associated with stress.
  2. UC: high prevalence with dependent personalities.
  3. CD: high rates of preexisting panic disorder.
17
Q

What kind of side-effects are most common with antidepressants?

TCAs?

A

GI-related due to serotinin’s role in GI tract.

  • > N/V and diarrhea
  • usually early on and dose-related

TCA side-effects tend to be anticholinergic: constipation and dry mouth.

18
Q

What disorders of the hepatic/pancreatic system are effected by stress? (3)

A
  1. Pancreatic carcinoma
  2. Acute intermittent porphyria
  3. Hepatic encephalopathy
19
Q

What disorders of the integumentary system are effected by stress? (3)

A
  1. Atopic dermatitis: increased prevalence with anxiety and depression.
  2. Psoriasis: related to anxiety, depression and personality disorders.
  3. Urticaria: related to anxiety and depression.
20
Q

What tumors are effected by stress? (3)

A
  1. *Frontal lobe tumor: mood changes, irritability, facetiousness, impaired judgment, impaired memory, delirium, loss of speech, loss of smell.
  2. Occipital lobe tumor: aura and visual hallucinations.
  3. Brain neoplasms: personality changes.
21
Q

What is treatment of psychosomatic disorders based around?

What are 4 means of therapy/treatment for psychosomatic disorders?

A

Stress management!

Self-Observation: Daily diary to keep record of stressors and reactions to stressors.

Cognitive Restructuring: Includes cognitive behavior therapy to substitute negative assumptions with positive assumptions.

Relaxation Exercises: Muscle relaxation techniques to teach relaxation to stressed/tense muscles.

Mindfulness: a mental state achieved by focusing one’s awareness on the present moment, while calmly acknowledging and accepting one’s feelings, thoughts, and bodily sensation.

22
Q

What is Consultation-Liason Psychiatry?

What problems do these psychiatrists often deal with? (6)

A

The study, practice, and teaching of the relation between medical and psychiatric disorders.

  • Suicide attempts/threats
  • Depression
  • Agitation: dementia
  • Hallucinations: delirium tremens (most common cause of hallucinations)
  • Sleep disorder
  • Confusion: delirium (most common cause of confusion in hospitalized pts. in general hospital)
23
Q

What 3 interventions can mitigate risk factors of delirium?

What absolutely MUST be avoided in elderly patients with delirium?

A

Orientation protocols - use clocks, windows, etc.

Cognitive stimulation - family visits, just avoid at nighttime.

Facilitate physiological sleep - avoid procedures/meds during sleeping hours. Reduce nighttime noise.

*MUST avoid Benzodiazepines in the elderly w/ delirium!

24
Q

What are the medical and psychiatric symptoms of PCP?

A

Medical Symptoms: Elevated BP, tachycardia, nystagmus, muscular rigidity, vomiting.

Psychiatric Symptoms: Agitation with blank stare, anxiety, stupor, aggression, panic, bizarre behavior.

25
Q

What are the medical and psychiatric symptoms of LSD?

A

Medical Symptoms: Sympathetic excess.

Psychiatric Symptoms: Sensory distortion, hypersensitivity of senses, euphoria, hallucinations.

26
Q

Which substance-induced organic mental disorders are associated with the following:

Corticosteroids

Benzodiazepines

Anti-Parkinson drugs

Antidepressants

A

Corticosteroids - mania, psychosis (hallucinations).**

Benzodiazepines - sedation, paradoxical agitation; avoid in the elderly!**

Anti-Parkinson drugs - psychotic symptoms, mania, anxiety.

Antidepressants - mania (in bipolar patients!)**

Neuromusculoskeletal & Psychiatry I Exam #1 (20 decks)

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