General Hospital Psychiatry Flashcards
What is liaison psychiatry?
- Subspecialty of psychiatry that works with patients in general hospitals
- Work with medical and surgical colleagues in the management of mental health problems in their patients
- Provides specialist care to patients with a range of problems including self harm, adjustment to illness, and physical and psychological co-morbidities
- Provide education for general hospital clinicians in the basics of management of mental health problems in the general hospital
What are some common mental health problems in general hospital?
- Self-harm
- Affective and adjustment disorders (depression, anxiety)
- Organic brain syndromes (delirium, dementia, amnesic syndromes)
- Personality disorders -Psychiatric disorders associated with substance misuse
- Eating disorders
- Functional disorders Less common:
- Schizophrenia
- Bipolar affective disorder
- Melancholia (Severe depression)
What are the reasons for increased psychiatric issues in hospital?
Challenges of physical illness:
- Psychological (incl. treatment)
- Effect of physical illness on brain functioning Treatment of physical illness, e.g. medication Increased physical morbidity in patients with mental health problems Functional (somatoform, dissociative…) disorders
What are some facts about self-harm?
- Self-harm commonest reason for admission in females < age 65
- More common in females but over recent years increase in self-harm rates in young males
- All patients admitted with self-harm should routinely receive a psychosocial (psychiatric) assessment
- Paracetamol commonest drug taken in overdose
What percentage of SH patients will repeat within a year?
15-20% (1% will commit suicide)
What issues is SH associated with?
- May be associated with significant mental illness and/or personality disorder (but often is not)
- Substance misuse common (alcohol, drugs)
- Often associated with multiple social problems
How is SH assessed (which 4 things must you identify)?
- Create an environment where a patient feels listened to, can experience relief and may begin to identify solutions
1) Identify risk factors for further self-harm, completed suicide
2) Identify mental disorder and need for further psychiatric treatment
3) Identify psychosocial stressors and patient’s way of coping
4) Identify appropriate help, even in absence of mental disorder - Patients should routinely receive an assessment after self harm
- Patients do not need to be “medically fit” to be assessed
- Do not need to wait until morning for assessment following self-harm – but that may be appropriate depending on individual circumstances.
What is delirium (acute organic confusional state) characterised by?
- 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
- May be mistaken for schizophrenia
How does delirium tremens present?
Vivid hallucinations
Delusions
Confusion
Tremor
Agitation
Sleeplessness
Autonomic overactivity
Impaired consciousness
How does delirium tremens appear on an EEG?
Fast activity
How does delirium tremens resolve?
- 5% mortality
- Usually lasts less than 72 hours
- Recurrent phases may rarely occur over a longer period of time
- On resolution of a prolonged attack, amnesic syndrome may remain - likely due to unnoticed Wernicke’s encephalopathy
- Mortality due to cardiovascular collapse, infection, hyperthermia or self-injury
How is delirium managed?
LOOK AT ORGANIC DISORDERS FLASHCARDS
How much more common is depression in hospitals compared to general population?
Twice as common
- 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
Alcohol use may lead to as much as 20% of all hospital admission. How may substance-misuse patients present?
- Physical complications
- Intoxication
- Withdrawal (including delirium)
- ARBD -Trauma/accident
- Drug-induced psychosis (e.g. novel psychoactive substances)
- Feigned illness in order to obtain drugs
What support may a substance-misuse patient receive when in hospital?
- Acute assessment of initial presentation
- Acute management of overdose
- Maintenance of safety
- Assessment of longer term mental health problems
- Referral onwards for appropriate care
How may an FND present to specialties?
