Inter-relating conditions of mind and body

Question 1

Name organic causes of the following psychiatric conditions:

1. depression (4)
2. Anxiety (5)
3. Irritability (3)
4. Altered behaviour (4)

Answer 1

1. hypothyroidism
   cushing’s
   steroid treatment
   brain tumour

2. thyrotoxicosis
    phaeochromocytoma
    hypoglycaemia
    complex partial seizures
    alcohol withdrawal

3. post-concussion syndrome
   frontal lobe syndrome
   hypoglycaemia
4. acute drug intoxication
   post ictal state
   acute delirum
   dementia

Question 2

1. Name 4 patient factors associated with increased risk of psychiatric illness in hospital setting
2. Name 4 hospital settings associated with increased risk of psychiatric illness
3. What day post surgery is commonly associated with the development of psychiatric conditions?

Answer 2

1. previous psychiatric hx
   current social or interpersonal stressors
   homelessness
   recent alcohol abuse
2. A&E
   endocrine, neurology and oncology wards
   ICU
   renal dialysis unit
3. second post op day

Question 3

1. Under what ICD-10 category are medically unexplained symptoms under?
2. Define the term “medically undexplained symptoms”

Answer 3

1. neurotic, stress related and somatoform disorders
2. physical symptoms not explained by organic disease, and for which there is positive evidence or a strong assumption that the symptoms are linked to psychological factors

Question 4

1. What is illness behaviour?

2. What is abnormal illness behaviour?

Answer 4

1. the ways in which given symptoms are differently perceived, evaluated and acted upon by different individuals
2. behaviour that occurs when there is a discrepancy between objective pathology and the patient’s response to it, in spite of adequate medical investigation and explanation

Question 5

Describe and briefly define the categories of abnormal illness behaviour

Answer 5

• ILLNESS DENIAL - behaviours to avoid the stigma/inability to accept physical/mental disease
• SOMATISATION - manifestation of psychological stress as physical symptoms
  
  • functional syndromes
  • chronic somatisation disorder
  • hypochondriasis
• SIMULATION - illnesses which are simulated, either consciously or unconsciously
  
  • unconsciously - dissociative and conversion disorders
  • conscious - factitious disorders and malingering

Question 6

Name examples of functional somatic syndrome

Answer 6

• tension headaches
• fibromyalgia
• chronic pain syndromes
• chronic fatigue syndrome
• irritable bowel sundrome
• irritable bladder

Question 7

Describe factors which reduce the possibility of symptoms having organic causes:

1. type of symptom
2. localisation
3. quality of symptom
4. site
5. system
6. quantity
7. consistency over time

Answer 7

1. pain and tiredness commonest
2. poor; doesn’t conform to anatomical principles
3. emotionally laden description
4. head and neck > abdo and chest > everywhere else
5. MSK > GI > CNS > other
6. as number increases, the chance of physical pathology decreases
7. symptoms shift to different systems

Question 8

Name factors commonly seen in functional and somatisation disorders:

1. predisposing (3)
2. Precipitating (5)
3. Perpetuating

Answer 8

1. perfectionist/introspective personality traits
   childhood trauma
   similar illness in first degree relatives
2. infections
   traumatic events
   acute painful conditions
   life events that precipitate changed behaviours (e.g. time off sick)
   incidents where patient believes others are responsible

3. inactivity with consequent physiological adaptation
    avoidant behaviours
    maladaptive illness beliefs
    excessive dietary restrictions
    stimulant drugs
    sleep disturnabce
    mood disorders

Question 9

Describe features of chronic somatisation disorder

Answer 9

• many unexplained symptoms
• frequent consultations and multiple investigations
• excessively disabled
• polypharmacy
• thick case notes
• dissatisfaction with care
• unrealistic of cure
• reluctant to accept that psychosocial factors may play a role

Question 10

What are the ICD-10 criteria for somatisation disorder

Answer 10

• at least 2 years of multiple and variable physical symptoms for which no adequate physical explanation has been found
• persistant refusal to accept advice/reassurance/negative test results
• behaviour/symptoms cause social and family impairment in functioning

Question 11

What is hypochondriasis?

Answer 11

• preoccupation with an assumed serious disease and its consequences
• Characteristically, such patients repeatedly request investigations either to prove they are ill or to reassure themselves that they are well (reassurance is often short lived)
• May exist with physical disease, but the patient’s concern is disproportionate and unjustified.

Question 12

1. What are dissociative disorders?

2. What are conversion disorders?

Answer 12

1. MENTAL SYMPTOMS - amnesia, non-epileptic attacks etc
2. PHYSICAL SYMPTOMS - paralysis, abnormal movements, sensory loss, false pregnancy

BOTH ARE UNCONSCIOUS FACTICIOUS DISORDERS

Question 13

1. What is the onset of dissociative/conversion disorders?
2. What is the underlying mechanism of dissociative/conversion disorders thought to do?
3. What is the common demographics of people with conversion/dissociative disorders?
4. Is function intact or disrupted?
5. Name 3 aetiological factors

Answer 13

1. acute, dramatic onset
2. defence mechanism
3. women; before 35 years
4. intact
5. stressful life events
   childhood neglect/abuse
   triggering of early mechanism

Question 14

1. What is malingering?
2. What is factitious disorder?
3. What are the 2 types of factitious disorder?

Answer 14

1. fabrication, feigning or exaggeration of physical/psychological symptoms designed to achieve a desired outcome such as relief of duty from work
2. condition in which a person without a malingering motive, acts if they have an illness by deliberately producing, feigning or exaggerating symptoms purely to attain a patient’s role. Motivation is to assume the sick role
3. Factitious disorder imposed on self
4. Factitious disorder imposed on another