Clinical Approach to Psychosomatic Disorders

Question 1

Patient comes in with fever, photosensitivity, butterfly rash, joint pains, and headache. What disease does the patient have? what are the psychiatric symptoms?

Answer 1

SLE

• depression, mood disturbance, psychosis, delusions, hallucinations

Question 2

What are the two psychiatric symptoms for multiple sclerosis?

Answer 2

anxiety and mania

Question 3

What are the psychiatric disorders associated with the cardiovascular system?

Answer 3

depression, anxiety, type A behavior, hostility, anger, and acut mental stress.

Question 4

What are the associated psychiatric symptoms with Asthma?

Answer 4

• Panic Disorder, anxiety

Question 5

A patient presents with heat intolerance, excessive sweating, diarrhea, weight loss, tachycardia, palpitations, hyperactivity. What do they have? what are there psychiatric symptoms?

Answer 5

Hyper thyroidism

• nervousness, excitability, agitation, pressured speech, insomnia, psychosis, visual hallucinations

Question 6

A patient presents with cold intolerance, dry skin, constipation, weight gain what do they have? what are their psychiatric symptoms?

Answer 6

Hypothyroidism

• lethargy, depressed, personality change, paranoia

Question 7

Patient has diabetes what are the psychiatric symptoms?

Answer 7

frustration, loneliness, dejection, depression

Question 8

Patient comes in with excessive thirst, polydipsia, stupor, coma, seizures and their glucose tolerance test is normal (no diabetes) what do they have? What are the psychiatric symptoms?

Answer 8

Hyponatremia

• confusion, lethargy, personality changes

Question 9

Chronic alcoholics can have this deficiency that leads to wernicke korsakoff syndrome? What are the psychiatric symptoms of this deficiency?

Answer 9

Thiamine

• poor concentration, confusion, confabulation (made up storied filling in gaps of lost memory)

Question 10

Patient comes in with pallor, dizziness, peripheral neuropathy, dorsal column signs, ataxia due to deficiency in _____. What are their psychiatric symptoms?

Answer 10

B12 - Cobalamin

• irritability, inattentiveness, psychosis, dementia

Question 11

What are the symptoms both medical and psychiatric for pancreatic carcinoma?

Answer 11

weight loss, abdominal pain, depression, lethargy, anhedonia, apathy, decreased energy

Question 12

Acute intermittent porphyria (AIP) is a heme synthesis deficiency disorder that may present with psychiatric features such _______? what are the medical symptoms?

Answer 12

Acute Depression, agitation, paranoia, visual hallucinations.

• medical symptoms include abdominal pain, fever, nausea, vomiting, constipation, peripheral neuropathy, paralysis

Question 13

If you see abdominal pain with fever and psychosis what should you be thinking?

Answer 13

Acute intermittent porphyria (AIP)

Question 14

What are medical symptoms and psychiatric symptoms of hepatic encephalopathy?

Answer 14

Medical - asterixis, hyperreflexia, spider angioma, palmar erythema, ecchymosis, liver enlargment

Psychiatric - euphoria, disinhibition, psychosis, depression

Question 15

Patient comes in with mood changes, irritability, facetiousness, impaired jeudgement, impaired memory, delirium loss of speech, loss of smell. What is causing this patients issue?

Answer 15

Frontal Lobe Tumor

Question 16

How do we know that a patient has a tumor as opposed to say schizophrenia or an isolated psychiatric disease?

Answer 16

• symptoms come out of nowhere
• no family history of psychosis
• no triggers or trauma

Question 17

What medications should be avoided in patients, specifically the elderly, that have delirium?

Answer 17

Benzodiazepines

Question 18

What are the medical symptoms and psychiatric symptoms of phencyclidine (PCP)?

Answer 18

Medical - elevated BP, tachycardia, nystagmus, muscular rigidity, vomiting

Psychiatric - agitation with blank stare, anxiety, stupor, aggression, panic, bizarre behavior

Question 19

Patient comes in with COPD or emphysema and one for the first line treatments is IV steroids what are the potentional psychiatric symptoms from this medication?

Answer 19

Mania, psychosis (hallucinations)