General Hospital Psychiatry and Somatisation Flashcards
Why are psychiatric conditions important to recognise in the general hospital?
- Provide appropriate mental health treatment
- Shorten length of treatment in hospital
- Avoidance of unnecessary investigations and inappropriate treatment
- Improve quality of life
What is liaison psychiatry?
Sub-specialty of psychiatry that deals with interface between mental and physical conditions
What are some common psychiatric problems in the 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 commonly
- Schizophrenia
- Bipolar affective disorder
- Melancholia (severe depression)
Self harm - aetiology
- Associated with significant mental illness and/or personality disorder
- Substance misuse common
- Social problems
Self harm - epidemiology
(age, sex)
What is done in the assessment for self-harm?
- Safe environment where patient feels listened to
- Identify risk factors for father self-harm or suicide
- Identify mental disorder and need for further psychiatric help
- Identify psychosocial stressors and patients way of coping
- Identify appropriate help
What is delirium in basic terms?
Acute organic confusional state
Delirium - epidemiology
(how common)
- Very common in general hospital (up to 20%)
Delirium - presentation
- 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 presented as rambling
- Changes in mood such as anxiety, depression and lability of mood
What is delirium characterised by?
- Characterised by global cognitive impairment
Delirium tremens - aetiology
- Most serious manifestation of alcohol withdrawal
Delirium tremens - presentation
- Often presents dramatically but may be a prodrome of insomnia, fearfulness, panic, nightmares
- Vivid hallucinations
- Delusions
- Confusion
- Tremor
- Agitation
- Sleeplessness
- Autonomic over activity
- Impaired consciousness
- EEG fast activity
- Usually lasts less than 72 hours
Delirium - management
- Environmental and supportive measures
- Education of relatives
- Make environment safe
- Optimise stimulation
- Orientation
- Correct factors contributing to delirium
- Medications
- Avoid sedation unless required for safety
- If using, start low dose – antipsychotics, benzodiazepines, promethazine
- Avoid antipsychotics in alcohol/drug withdrawal unless patient well covered with benzodiazepines due to lowering of seizure threshold
Delirium - prognosis
- Morality 5%
- Mortality due to cardiovascular collapse, infection, hyperthermia or self-injury
Depression - epidemiology
(how common)
- 2x common in hospital compared to general population
- More common in chronic illness and people with past history of depression
Substance misuse - epidemiology
- 20% of admissions directly related to ill effects of alcohol use
Substance misuse - presentation
- Physical complications
- Intoxication
- Withdrawal (including delirium)
- ARBD
- Trauma/accident
- Drug-induced psychosis
- Feigned illness in order to obtain drugs
What does functional disorders mean?
Umbrella term to describe real physical symptoms that are not caused by structural lesion, but by the functioning of bodily systems:
- Dissociative disorders
- Somatoform disorders
- Other neurotic disorders
- Neurasthenia (CFS)
What are the different classifications of functional disorders?
- Dissociative disorders
- Somatoform disorders
- Other neurotic disorders
- Neurasthenia (CFS)
Is a functional disorder a factitious disorder?
Different from factitious disorder, which is where patient does something for unconscious reasons unknown to them
Functional disorders - presentation
Presents in all systems
Functional disorder - management
- Explanation of FND
- Medication for co-morbid mental health problems
- Psychological therapies
- CBT
- Others including IPT and psychodynamic therapies
- Other therapies for co-morbid disorders
