General Hospital Psychiatry

Question 1

Reasons for increased prevalence of mental health problems in hospital patients

Answer 1

Challenges of physical illness 
- psychological 
- effect on brain functioning
- treatment 
Somatoform disorders 
Increased physical morbidity in patients with mental health problems

Question 2

What are somatoform disorders?

Answer 2

Medically unexplained symptoms

Question 3

Common mental health problems in the general hospital

Answer 3

Affective disorders (anxiety, depression)
Self harm
Delirium (acute organic confusional state)
substance misuse disorders
medically unexplained symptoms (somatoform disorders)
personality disorders
dementia
eating disorders

Question 4

Depression association to hospitals

Answer 4

2x as much as in the general pop

Question 5

When is depression more common?

Answer 5

In chronic illness e.g. chronic renal failure, DM, RA
particularly common in neurological diseases e.g. MS, parkinsons, stroke
Previous history of depression

Question 6

Features of delerium

Answer 6

usually acute or subacute
global cognitive impairment
disorientation in time and place
fluctuating levels of arousal
impaired attention/concentration
disordered sleep wake cycle
increased / decreased motor activity
Disorganised thinking - rambling, irrelevant or incoherent speech
perceptual distortions leading to misidentification, illusions or hallucinations
changes in mood e.g. anxiety, depression and lability of mood

Question 7

Causes of delirium

Answer 7

Infections
endocrinopathies
neurological causes
medications
alcohol/drug withdrawal 
drug abuse
metabolic 
vitamin deficiencies 
toxins/industrial exposures 
SLE
cerebral vasculitis
paraneoplastic syndromes

Question 8

What is the commonest reason for admission in females < 65?

Answer 8

Self harm

Question 9

How many patients, if self harm, will repeat in one year?

Answer 9

15-20%

Question 10

How many patients after self harm will go onto commit suicide in one year?

Answer 10

approx. 1%

Question 11

What is the commonest drug taken in overdose for self harm?

Answer 11

Paracetomal

Question 12

What is self harm often associated with?

Answer 12

significant mental illness and / or personality disorder
substance misuse (alcohol, drugs)
multiple social problems

Question 13

Substance misuse / dependence presentation in hospital

Answer 13

physical complications
intoxication 
withdrawal (inc delirium, ARBD)
trauma / accident
drug induced psychosis (e.g. legal highs)
feigned illness in order to obtain drugs

Question 14

What does the prevalence of dementia increase with?

Answer 14

Age

Question 15

What are the principle causes of admission in people with dementia?

Answer 15

UTI

pneumonia

Question 16

Importance of recognising psychiatric disorders in general hospital patients

Answer 16

Provide appropriate mental health treatment
Shorten length of treatment in hospital
avoidance of unnecessary investigations and inappropriate treatment
enhance recovery and rehab process
improve QoL

Question 17

Mental health provisions in hospitals

Answer 17

Liason psychiatry services 
Psychology 
Alcohol liaison nursing team 
ward teams
no specific counselling service
pastoral care

Question 18

What can be used to reverse acute dystonia that would be induced by haloperidol?

Answer 18

Procyclidine