General Hospital Psychiatry and Somatisation Flashcards
1
Q
Why are psychiatric conditions important to recognise in the general hospital?
A
- Provide appropriate mental health treatment
- Shorten length of treatment in hospital
- Avoidance of unnecessary investigations and inappropriate treatment
- Improve quality of life
2
Q
What is liaison psychiatry?
A
Sub-specialty of psychiatry that deals with interface between mental and physical conditions
3
Q
What are some common psychiatric problems in the general hospital?
A
- 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)
4
Q
Self harm - aetiology
A
- Associated with significant mental illness and/or personality disorder
- Substance misuse common
- Social problems
5
Q
Self harm - epidemiology
(age, sex)
A
6
Q
What is done in the assessment for self-harm?
A
- 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
7
Q
What is delirium in basic terms?
A
Acute organic confusional state
8
Q
Delirium - epidemiology
(how common)
A
- Very common in general hospital (up to 20%)
9
Q
Delirium - presentation
A
- 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
10
Q
What is delirium characterised by?
A
- Characterised by global cognitive impairment
11
Q
Delirium tremens - aetiology
A
- Most serious manifestation of alcohol withdrawal
12
Q
Delirium tremens - presentation
A
- 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
13
Q
Delirium - management
A
- 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
14
Q
Delirium - prognosis
A
- Morality 5%
- Mortality due to cardiovascular collapse, infection, hyperthermia or self-injury
15
Q
Depression - epidemiology
(how common)
A
- 2x common in hospital compared to general population
- More common in chronic illness and people with past history of depression
21
Q
Functional disorders - presentation
A
Presents in all systems
