Endocrine Disorders and Psychiatry

Question 1

What psychiatric condition is more common in someone with diabetes

Answer 1

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

Question 2

weight gain improves or worsens insulin resistance

Answer 2

worsens; also associated with obstructive sleep apnea

Question 3

most common psychiatric condition in hypercortisolemia

Answer 3

depression most common;

- anxiety, hypomania/mania, psychosis and cognitive dysfunction

Question 4

T/F: weight gain is not associated with obstructive sleep apnea

Answer 4

False; it IS

Question 5

in hyperadrenalism, physical signs always come before psychiatric

Answer 5

False; can have psych conditions appearing before physical signs

Question 6

ppl with hyperparathyroidism may experience what psych conditions

Answer 6

depression, apathy, irritability, lack of initiative, and lack of spontaneity

• Severe hypercalcemia can cause delirium, psychosis, catatonia, or lethargy and can progress to coma

Question 7

psych conditions in pts with hypocalcemia

Answer 7

Mild: anxiety, paresthesias, irritability, and emotional lability

severe hypocalcemia– Mania, psychosis, tetany, seizures are common

Question 8

do psych conditions commonly appear later in life (4th adn 5th decade)

Answer 8

No; if someone having new sxs at this time, look for endocrine problem maybe

Question 9

endocrine abnormalities present particularly in which psych condition

Answer 9

depression

Question 10

Psych sxs associated with Addison’s dz

Answer 10

apathy, anhedonia, fatigue, depression

Question 11

psych sxs associated with acromegaly

Answer 11

mood lability, personality change, depression

Question 12

most frequently occurring thyroid diseases in adults

Answer 12

autoimmune disorders (Hashimoto’s, Graves’)

Question 13

high concentration of T3 receptors in what parts of brain

Answer 13

amygdala and hippocampus

Question 14

how common is subclinical hypothyroidism

Answer 14

4-8% in adults who don’t have known thyroid disease;

- up to 20% of women over age 60

Question 15

labs in subclinical hypothyroidism

Answer 15

TSH elevated, but low to nl T4 with few/no sxs

Question 16

is complete resmissino fo depression common

Answer 16

only 35-45% depressed pts achieve complete remission with antidepressants
- rest are initially treatment resistant (25%) or just partial response (15%)

Question 17

implication of partial response to depression medications

Answer 17

can lead to increased recurrence, treatment resistance, suicide, increased health-care utilization, and poor social and work functioning if not addressed

Question 18

association between treatment-resistant depression and subclinical hypothyroidism

Answer 18

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

Question 19

T/F treatment resistant depression doesn’t respond to thyroid hormone supplementation

Answer 19

False; it does respond without lab evidence of thyroid malfunction

Question 20

how common is postpartum thyroiditis

Answer 20

5-8% pregnancies followed by postpartum thyroiditis, which may result in permanent hypothyroidism

Question 21

typical thyroiditis progression

Answer 21

initially hyperthyroidism then hypothyroidism;

Question 22

Sheehan syndrome

Answer 22

hypo-pituitarism due to postpartum pituitary necrosis–rare

Question 23

psych conditions associated with thyrotoxic pts

Answer 23

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

Question 24

hypo/hyperthyroidism can present with what psych conditions

Answer 24

depression, fatigue, anxiety

Question 25

Do most pts with primary mood disorder have overt thyroid disease?

Answer 25

No; relative abnormalities, including subclinical hypothyroidsm, associated with worse outcomes

Question 26

what 2 conditions can treatment with thyroid replacement ‘especially’ help

Answer 26

treatment resistance and rapid cycling bipolar disorder

Question 27

women or men more common to have thyroid disorders

Answer 27

women

Question 28

do psychosis (myxedema madness), delusions, visual & auditory hallucinations typically develop before or after physical sxs?

Answer 28

typically after, often after a pd of years or months

Question 29

negative consequence of untreated hypothyroidism

Answer 29

irreversible dementia when not treated in time

Question 30

how common is subclinical hypothyroidism

Answer 30

8% women (10% over age 55; 20% over 60) and 3% menhave subclinical hypothyroidism

Question 31

psych sxs of clinical hypothyroid

Answer 31

emotional lability, depression, fatigue, forgetfulness, mental slowness
- can mimic dementia

Question 32

subclinical hypothyroidism a risk factor for

Answer 32

depression, treatment-resistant depression, rapid cycling bipolar disorder

Question 33

is psychosis related to absolute degree of thyroid hormone deficit?

Answer 33

probably not; see disorders of thought n both subclinical and clinical hypothyroidism

Question 34

T/F Graves is found more frequently in presence of autoimmune disease

Answer 34

TRUE