Endocrine Disorders and Psychiatry Flashcards
What psychiatric condition is more common in someone with diabetes
Depression is 2-3x more common in diabetics. Results in poorer glycemic control and increased diabetic complications
- Increased Type 2 diabetes in pts with bipolar–some due to increased obesity in bipolar pts and some due to meds
weight gain improves or worsens insulin resistance
worsens; also associated with obstructive sleep apnea
most common psychiatric condition in hypercortisolemia
depression most common;
- anxiety, hypomania/mania, psychosis and cognitive dysfunction
T/F: weight gain is not associated with obstructive sleep apnea
False; it IS
in hyperadrenalism, physical signs always come before psychiatric
False; can have psych conditions appearing before physical signs
ppl with hyperparathyroidism may experience what psych conditions
depression, apathy, irritability, lack of initiative, and lack of spontaneity
- Severe hypercalcemia can cause delirium, psychosis, catatonia, or lethargy and can progress to coma
psych conditions in pts with hypocalcemia
Mild: anxiety, paresthesias, irritability, and emotional lability
severe hypocalcemia– Mania, psychosis, tetany, seizures are common
do psych conditions commonly appear later in life (4th adn 5th decade)
No; if someone having new sxs at this time, look for endocrine problem maybe
endocrine abnormalities present particularly in which psych condition
depression
Psych sxs associated with Addison’s dz
apathy, anhedonia, fatigue, depression
psych sxs associated with acromegaly
mood lability, personality change, depression
most frequently occurring thyroid diseases in adults
autoimmune disorders (Hashimoto’s, Graves’)
high concentration of T3 receptors in what parts of brain
amygdala and hippocampus
how common is subclinical hypothyroidism
4-8% in adults who don’t have known thyroid disease;
- up to 20% of women over age 60
labs in subclinical hypothyroidism
TSH elevated, but low to nl T4 with few/no sxs
is complete resmissino fo depression common
only 35-45% depressed pts achieve complete remission with antidepressants
- rest are initially treatment resistant (25%) or just partial response (15%)
implication of partial response to depression medications
can lead to increased recurrence, treatment resistance, suicide, increased health-care utilization, and poor social and work functioning if not addressed
association between treatment-resistant depression and subclinical hypothyroidism
one studey showed about 50% pts with treatment-resistant depression had evidence of subclinical hypothyroidism
- compared to 8-17% in unselected population of depressed pts
T/F treatment resistant depression doesn’t respond to thyroid hormone supplementation
False; it does respond without lab evidence of thyroid malfunction
how common is postpartum thyroiditis
5-8% pregnancies followed by postpartum thyroiditis, which may result in permanent hypothyroidism
typical thyroiditis progression
initially hyperthyroidism then hypothyroidism;
Sheehan syndrome
hypo-pituitarism due to postpartum pituitary necrosis–rare
psych conditions associated with thyrotoxic pts
anxiety (60% thyrotoxic pts have anxiety disorder)
- 31-69% have depressive disorder
- pts can become manic but usually have underlying mood disorder or positive fam hx for bipolar illness
hypo/hyperthyroidism can present with what psych conditions
depression, fatigue, anxiety
Do most pts with primary mood disorder have overt thyroid disease?
No; relative abnormalities, including subclinical hypothyroidsm, associated with worse outcomes
what 2 conditions can treatment with thyroid replacement ‘especially’ help
treatment resistance and rapid cycling bipolar disorder
women or men more common to have thyroid disorders
women
do psychosis (myxedema madness), delusions, visual & auditory hallucinations typically develop before or after physical sxs?
typically after, often after a pd of years or months
negative consequence of untreated hypothyroidism
irreversible dementia when not treated in time
how common is subclinical hypothyroidism
8% women (10% over age 55; 20% over 60) and 3% menhave subclinical hypothyroidism
psych sxs of clinical hypothyroid
emotional lability, depression, fatigue, forgetfulness, mental slowness
- can mimic dementia
subclinical hypothyroidism a risk factor for
depression, treatment-resistant depression, rapid cycling bipolar disorder
is psychosis related to absolute degree of thyroid hormone deficit?
probably not; see disorders of thought n both subclinical and clinical hypothyroidism
T/F Graves is found more frequently in presence of autoimmune disease
TRUE
