General Hospital Psychiatry Flashcards
Why are mental health problems in general hospital patients not always recognised?
May disguise themselves as a physical disorder
Focus on physical disorder, mental symptoms not always inquired about
Reaction considered to be normal
What is the effect of mental health problems in general hospital patients?
Can affect management of physical condition
General hospital staff may feel ill-equipped to deal with such problems
What are the reasons for increased prevalence of mental health problems in general hospital patients?
Challenges of physical illness
- psychological (including treatment e.g. painful, uncertain, disfiguring)
- effect of physical illness on brain functioning
- treatment of physical illness e.g. medication
Increased physical morbidity in patients with mental health problems
Somatoform disorders
What are the mental health problems commonly seen in the general hospital setting?
Affective disorders Self-harm Delirium Substance misuse disorders Medically unexplained symptoms Personality disorders Dementia Eating disorders
What mental health problems are less commonly seen in general hospital setting?
Schizophrenia
Bipolar affective disorder
Severe depression
How common is depression in general hospital patients compared to in general population?
Twice as common in general hospital patients
When is depression more common in general hospital patients?
Chronic illness e.g. diabetes, chronic renal failure
Neurological diseases e.g. MS, Parkinson’s disease, stroke
Patients with previous history of depression
Why might depression be more difficult to detect in general hospital patients?
May be more difficult to detect due to overlap in symptomatology with physical disorder
How common is delirium in general hospital patients?
Up to 20% of patients
What are the features of delirium in general hospital patients?
Usually acute or subacute onset Characterised by global cognitive impairment Disorientation in time and place Fluctuating levels of arousal Impaired attention/concentration Disordered sleep/wake cycle
What is the presentation of delirium in general hospital patients?
Increased or decreased motor activity - hyper/hypo-active delirium
Disorganised thinking, indicated by rambling, irrelevant or incoherent speech
Perceptual distortions leading to misidentification, illusions or hallucinations
Changes in mood e.g. anxiety, depression, lability of mood
May be mistaken for schizophrenia
What are the causes of delirium in general hospital patients?
Infections Medications Alcohol/drug withdrawal Drug abuse Metabolic Vitamin deficiencies Endocrinopathies Neurological causes Toxins/industrial exposures SLE Cerebral vasculitis Paraneoplastic syndromes
What is the commonest reason for hospital admission in females < age 65?
Self0harm
What are the admission rates at ARI for self-harm
Around 790 episodes in 2015
What assessment will all patients admitted with self-harm routinely receive?
Psycho-social (psychiatric) assessment
What percentage of patients admitted for self-harm will repeat within one year?
15-20%
What percentage of patients admitted for self-harm will go on to commit suicide within one year?
1%
What is the commonest drug taken in overdose?
Paracetamol
What might self-harm be associated with?
Significant mental illness and/or personality disorder (but often is not)
Substance misuse - drugs and alcohol
Multiple social problems
What percentage of general hospital admissions are directly related to the ill-effects of alcohol use?
20%
How might substance misuse present to general hospital?
Physical complications Intoxication Withdrawal - delirium ARBD Trauma/accident Drug-induced psychosis Feigned illness in order to obtain drugs
What number of new neurology outpatients will have medically unexplained physical symptoms?
1/3rd
What are the difficulties of patients with medically unexplained physical symptoms that may be due to a psychiatric problem in general hospital patients?
Can present to any specialty
May be subject to multiple investigations and inappropriate treatment
Can be difficult to help
Often have significant disability
May have other underlying psychiatric disorder
What percentage of general hospital beds are occupied by patients over the age of 65?
Around 60%
What does the prevalence of dementia increase with?
Age
In acute medical admissions, what percentage of patients aged 70-79, and aged over 90 will have dementia?
Age 70-79
- males 16.4%
- females 29.6%
Age over 90
- males 48.8%
- females 75%
What are the principal causes of admission in 41.3% of people with dementia?
Urinary tract infection or pneumonia
What are the problems associated with dementia patients in the general hospital setting?
Often not recognised Cognitive impairments can be exacerbated by physical problems Increases risk of delirium Often affects patient's management Increases length of hospital stay
What might an eating disorder be mistaken for in the general hospital setting?
Primary physical disorder
Why is it important to recognise psychiatric disorders in general hospital patients?
Provide appropriate mental health treatment
Shorten length of treatment in hospital
Avoidance of unnecessary investigations and inappropriate treatment
Enhance recovery and rehabilitation process
Improve quality of life
What are the current mental health provisions available in the 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
