General Hospital Flashcards
What are the problems in the general hospital with MH problems?
Not always recognised = may be disguised as physical disorder
Can affect the management of a physical condition
Staff may not be able to deal with such problems
What are the reasons for increased prevalence?
Challenges of physical illness
Increased physical morbidity in patients with mental health problems
Functional disorders
What are the common MH problems in GH?
Affective disorders Self-harm Delirium Substance misuse Functional disorders Personality disorders Dementia Eating disorders
Depression and the GH
2x more common in GH
Common in chronic illness and neurological disease
Difficult to detect due to overlap with physical disorders
Delirium and the GH
Up to 20% Usually acute onset Global cognitive impairment Disorientation Fluctuating arousal Impaired concentration and thinking Disordered sleep wake cycle Increased / decreased motor activity May be mistaken for schizophrenia
Self-harm and the GH
More common in females
Patients receive psyco-social assessment
15-20% repeat in 1 year
Paracetamol common
Substance misuse / dependence and the GH
May present as:
Physical complications, intoxication, withdrawal, ARBD, trauma or accident, drug-induced psychosis and feigned illness to obtain drugs
Dementia and the GH
60% of beds occupied by patients over 65 Pevelance increases with age UTI or pneumonia principle cause Cognitive impairment exacerbated by physical problems Increases risk of delirium Affects management and length of stay
Eating disorders and the GH
More common in younger females
Require physical stabilisation and appropriate diagnosis
Importance of recognising MH problems in the GH
Provide MH treatment
Shorten length of stay
Avoid unnecessary investigations and treatment
Enhance rehab and improve QOL
Functional disorders and the GH
Medically unexplained symptoms
Dissociative
Somatoform
Factitious
1/3 new neurology outpatients, present to all specialities
Often significant disability and may have underlying co-morbid psychiatric disorder, 2/3 have MH history
What are the treatments for functional disorders?
Explanation of FND
Medications for co-morbid MH problems
Psycological therapies (CBT + IPT + psychodynamic)
