Introduction to psychiatry Flashcards
Many long term physical conditions are risk factors for the development of mental disorders, give examples of some of these conditions and the disorders they can cause?
- Cardiovascular disease – Associated with 3x increase risk of depression/anxiety
- MSK disorders – Associated with 2x increase risk of depression
- Diabetes – Associated with 2x increase risk of depression
- COPD – Associated with 10x increased risk of panic disorder
Physical illness can also cause mental illness, give examples
- Hyperthyroidism-> anxiety, mania
- Hypothyroidism->depression, cognitive impairment
- Cushing’s syndrome -> depression
- Infections (syphilis, HIV) -> psychosis, dementia
- Systemic lupus erythematosus (SLE) -> depression
- Cancer -> depression
- Parkinson’s disease -> depression, anxiety, dementia, psychosis
- Phaeochromocytoma -> anxiety
Certain medications can cause mental disorders as an adverse effect, give examples
- Dopamine agonists -> Psychosis
- L-dopa psychosis, delirium, anxiety, depression
- Steroids (prednisolone) -> depression, mania, psychosis, anxiety
- Isoniazid (TB antibiotic) -> mania, psychosis
- Anticholinergics -> delirium, anxiety, psychosis
- Isoretinoin (Roaccutane) -> depression
- Digoxin -> depression, psychosis
- Interferon alpha -> depression, mania, psychosis
What is meant by the “mortality gap”?
People with chronic mental illness are at greater risk of all cause mortality; the so called “mortality gap”
mental illness can put people at greater risk of physical illness, why?
Multifactorial Cause:
Medication adverse effects (e.g. weight gain, dyslipidaemia, insulin insensitivity, hypertension, sedation)
Increased rates of smoking, illicit substance use and alcohol intake
Poor diet and exercise
Chaotic lifestyles and low socioeconomic status
How are the negative effects of mental illness on the physical health managed/ reduced?
Management:
Choose medication that minimises impact on physical health
E.g. weight gain sparing antidepressants and antipsychotics in those already with increased BMI
Monitoring of cardiometabolic factors (BMI, HbA1C, lipid profile, blood pressure)
Smoking cessation
Dietary advice
Drug and alcohol services
Mental illness may present with physical symptoms. true or false?
TRUE
What factors may affect timely diagnosis of physical disorders in people with mental illness?
Illness behaviour (patient might not seek help)
Diagnostic overshadowing (misattribution of physical symptoms to psychiatric symptoms)
Stigma
Lack of resources/lack of access to services
How does our brain work to make accurate perceptions?
Our brain has a tremendous amount of sensory information coming at it, and a very small part reaches the conscious information at any one point
Anexternal objectis represented internally by asensory perceptthat combines with memory and experience to produce ameaningful internal perceptin the conscious mind.
What are the 2 types of perceptual abnormalities you can have?
1) Altered perceptions—includingsensory distortionsandillusions—in which there is a distorted internal perception of a real external object & the brain alters the interpretation to try and make sense of it
2) False perceptions—includingtrue hallucinations and pseudo-hallucinations —in which there is an internal perception without an external object (you’re aware that the external object is not there but still sees it)
What type of hallucinations can you have?
- True hallucinations
- Pseudo-hallucinations —in which there is an internal perception without an external object (you’re aware that the external object is not there but still sees it)
Hallucinations can also be in any sensory modality
- Visual hallucinations (most common type in delirium): sight
- Auditory hallucinations:s sounds
- Gustatory or olfactory hallucinations: smells
- Tactile hallucinations : touch
Isolated hallucinatory experiences are normal and relatively common phenomena, true or false
TRUE
What test can be used for a quick assessment of cognitive dysfunction?
MOCA test “Montreal Cognitive Assessment”
What is delirium?
organic cerebral syndrome characterized by concurrent disturbances of consciousness and attention, perception, thinking, memory, psychomotor behaviour, emotion, and the sleep-wake schedule. The duration is variable and the degree of severity ranges from mild to very severe
- Delirium is a psychiatric manifestation of a physical illness
Why does Delirium occur?
(true/ single cause unknown/ unlikely)
A critical illness leads to increased cortisol and cerebral hypoxia ( older adults predisposed) which leads to↓acetylcholine synthesis and dysfunctions of hippocampal and neocortical areas (↑500 times dopamine and↑adrenergic output)(Maldonado 2008)
This critical illness, can be anything- including but not limited to
Infection (Urine, pneumonia, cellulitis, wound etc)
Change in environment (ITU, HDU, ward)
Medication (opiates, anticholinergics, steroids)
Alcohol withdrawal
Surgery
Pain
Major organ damage
Hyponatremia
Stroke
Dehydration
