Introduction to psychiatry

Question 1

What is an adjustment reaction?

Answer 1

A state of significant mental distress, interfering with social functioning, that arises from a significant life change/ stressful life event

Manifests as
-depressed mood
-anxiety
-worry
-a feeling of inability to cope, plan ahead or continue in the present situation
-a degree of disability in performance of daily routine

Question 2

What is an organic delusional disorder?

Answer 2

A disorder that involves persistent delusions (and sometimes hallucinations) as a consequence of physical illness
May include symptoms suggestive of schizophrenia like bizarre hallucinations or thought disorder

Question 3

What is the prevalence of delusions and hallucinations in post stroke psychosis?

Answer 3

Delusions in 5%, hallucinations in 5%

Question 4

What type of stroke is post stroke psychosis most common in?

Answer 4

right hemisphere strokes (5:1)

Question 5

What are common delusional themes in post stroke psychosis?

Answer 5

Persecutory- where you think someone is putting you in danger
Jealousy
Delusions about the environment

Question 6

What kind of treatment response does post stroke psychosis have?

Answer 6

Treatment response is unknown
Few people respond well to any treatment

Question 7

Why do lots of people with long term conditions also have mental health issues?

Answer 7

Long term conditions cause disability, inability to work or socialise
Some medications like high dose steroids can cause mental health problems

Question 8

Why do people with mental health issues also have long term conditions?

Answer 8

• Chronic stress leads to excess cortisol
• Antipsychotics can have long term negative effects on CV system that can increase risk of heart disease and stroke
• Mental health issues people tend to have unsafe lifestyle choices e.g. smoke and drink more
• Or they won’t want to access care because of pessimism

Question 9

What long term medical conditions are associated with increased risk of mental illness?

Answer 9

Cardiovascular disease- 3x risk of depression and anxiety
COPD- 10x risk of panic disorder
Diabetes-2x risk of depression
MSK disorders- 2x risk of depression

Question 10

What physical illnesses cause discrete mental illness?

Answer 10

Thyrotoxicosis- anxiety, mania
Thyroid deficiency- depression, dementia
Cancer- depression
Cushing’s disease- depression
Infections (HIV, syphillis)- psychosis
Parkinson’s disease- depression, dementia, anxiety

Question 11

What is endogenous vs exogenous steroid excess more linked with in terms of mental illness?

Answer 11

• Endogenous steroid excess (e.g. in Cushing’s) seems to be more linked to depression
• Exogenous steroid excess seems to be more linked to mania

Question 12

How much earlier do people with chronic mental illness die than the general population?

Answer 12

20 years younger

Question 13

What factors may affect timely diagnosis of physical disorders in people with mental illness?

Answer 13

Illness behaviour
Diagnostic overshadowing
Stigma
Lack of resources

Question 14

Define delirium

Answer 14

An organic cerebral disorder characterised by simultaneous disturbances in consciousness and attention, perception, thinking, memory, psychomotor behaviour, sleep and wake schedule and emotion

Duration is variable and degree of severity varies from mild to very severe

Question 15

How prevalent is delirium?

Answer 15

20% of acute hospital patients >65 have delirium
20% develop delirium after admission
So overall 40% of hospital patient >65 have delirium

50% of delirium is undetected

Question 16

What are the 2 types of delirium?

Answer 16

Hypoactive delirium- patients are confused but quiet and not causing a problem, therefore goes undetected as delirium
Hyperactive delirium- irritable, aggressive, shouting, hitting, throwing things

Question 17

What are the negative outcomes of delirium?

Answer 17

Delays discharge- you’re likely to stay in hospital a week longer if you have delirium
Increases mortality by unto 40%

Question 18

Causes of delirium?

Answer 18

Liver/ renal impairment- important
Hyponatraemia- important
Urine retention
Dehydration
Constipation- common cofactor in leading to delirium in elderly
Alcohol withdrawal- leads to hallucinations and strong tremors
Infections (urine, pneumonia, wound, cellulitis)
Encephalitis
Medications (opiates, steroids, anticholinergics)
Stroke
Hypoxia
Pain
Surgery
Change in environment (ITU, HDU, ward)

Question 19

What are some predisposing factors for delirium?

Answer 19

Age
Dementia (often undetected)
Impaired activities of daily living
Immobility
Sensory impairment
Urinary cathetarisation
Malnutrition
Alcohol
Depression

Question 20

How is delirium managed?

Answer 20

Anticipate
Modify risk factors if possible
Early diagnosis
Treat the underlying causes
Good nursing (single room, well lit, familiar staff/ family ideally)
Medication
Wait!

Question 21

What is stigma in relation to mental health?

Answer 21

Challenges faced by people with mental illnesses in relation to the knowledge, behaviour and attitudes of people they meet
This includes:
Poor understanding of mental illness
Social exclusion
Negative attitudes
(75% of people w/ mental illness experience stigma)

Question 22

What negative effects do stigma lead to?

Answer 22

Leads to discrimination, abuse, rejection, isolation

• Increases the disability caused by mental illness
• Creates disadvantage with personal relationships, education and work
• Barrier to accessing care

Question 23

What types of stigma are there?

Answer 23

Intra personal: direct effect on individual, internalised stigma-compounded by direct effects of the illness

Interpersonal (friends, family, colleagues)

Structural: poor resources, funding, access to physical healthcare