General hospital psych Flashcards
reasons for increasing prevelance of mental health disorders in the hospital
Challenges of physical illness: Psychologically challenging – including treatment, Effect of physical illness on brain functioning, Effects of treatment of physical illness – e.g. medication. Increased physical morbidity in patients with mental health problems and functional disorders
list the common mental health problems in the general hospital
Affective disorders – e.g. depression, anxiety, Self-harm – often go to A&E first, Delirium = acute organic confusional state, Substance misuse disorders, Medically unexplained symptoms = somatoform disorders, Personality disorders, Dementia, Eating disorders.
outline depression in hospital
Twice as common in general hospital patients than general population, More common in chronic illness, e.g. chronic renal failure, diabetes, rheumatoid arthritis, Particularly common in certain neurological diseases, e.g. MS, Parkinson’s disease, stroke, May be more difficult to detect due to overlap in symptomatology with physical disorder(s), More common in patients with previous history of depression
outlinen delerium in hospital
Very common in general hospital patients (up to 20%), Usually acute or sub-acute onset, Characterised by global cognitive impairment, Disorientation in time and place Fluctuating levels of arousal, Impaired attention/concentration, Disordered sleep wake cycle
Increased/decreased motor activity (hyperactive/hypoactive delirium), Disorganised thinking, as indicated by rambling, irrelevant or incoherent speech, Perceptual distortions leading to misidentification, illusions or hallucinations, Changes in mood, such as anxiety, depression and lability of mood, May be mistaken for schizophrenia.
self harm
More common in females but recent increase in young males, All patients admitted with self-harm will routinely receive a psychiatric assessment, 15-20% of patients will repeat within one year – 1% will go on to commit suicide within one year, Paracetamol is commonest drug taken in overdose – because it is the most widely available drug, Substance misuse common, Often associated with multiple social problems
substance misuse/dependence
• ~20% of admissions are directly related to the ill effects of alcohol use, May also present as: Physical complications, Intixication, Withdrawal – e.g. delirium, ARBD, Trauma/accident, Drug induced psychosis – esp. ‘legal highs’, Feigned illness – iot obtain drugs
Dementia is hospital
Patients <65 = pre-senile dementia, In acute medical admissions in patients > 90 they are very like to have dementia, Much higher prevalence in females, UTI and pneumonia are principle cause of admission in people with dementia, Cognitive impairment can be extracted by physical problems, Increases risk of delirium, Often affects patients management and increases length of hospital stay.
eatinng disorders
Primary physical disorder may be suspected initially, May initially require physical stabilisation and appropriate diagnosis
medically unnexplained physcial symptoms
Referred by GP but no explanation found for their physical symptoms: 1/3 of new neurology outpatients have no explanation for symptoms, Can present to all specilities, May end up subjected to multiple investigations and inappropriate treatment – strain on services and patient, Often have a significant disability, May have underlying psychiatric disorder
what are some mental health provisions in general hospital?
Liaison psychiatry services, Working adults (18-65) and old age, Psychology: Only available in some areas – e.g. diabetes, oncology, pain, Neuropsychology, Alcohol liaison nursing team, Ward teams, No specific counselling service, Pastoral care
