Introduction to psychiatry Flashcards
What is an adjustment reaction?
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
What is an organic delusional disorder?
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
What is the prevalence of delusions and hallucinations in post stroke psychosis?
Delusions in 5%, hallucinations in 5%
What type of stroke is post stroke psychosis most common in?
right hemisphere strokes (5:1)
What are common delusional themes in post stroke psychosis?
Persecutory- where you think someone is putting you in danger
Jealousy
Delusions about the environment
What kind of treatment response does post stroke psychosis have?
Treatment response is unknown
Few people respond well to any treatment
Why do lots of people with long term conditions also have mental health issues?
Long term conditions cause disability, inability to work or socialise
Some medications like high dose steroids can cause mental health problems
Why do people with mental health issues also have long term conditions?
- 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
What long term medical conditions are associated with increased risk of mental illness?
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
What physical illnesses cause discrete mental illness?
Thyrotoxicosis- anxiety, mania
Thyroid deficiency- depression, dementia
Cancer- depression
Cushing’s disease- depression
Infections (HIV, syphillis)- psychosis
Parkinson’s disease- depression, dementia, anxiety
What is endogenous vs exogenous steroid excess more linked with in terms of mental illness?
- 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
How much earlier do people with chronic mental illness die than the general population?
20 years younger
What factors may affect timely diagnosis of physical disorders in people with mental illness?
Illness behaviour
Diagnostic overshadowing
Stigma
Lack of resources
Define delirium
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
How prevalent is delirium?
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
What are the 2 types of delirium?
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
What are the negative outcomes of delirium?
Delays discharge- you’re likely to stay in hospital a week longer if you have delirium
Increases mortality by unto 40%
Causes of delirium?
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)
What are some predisposing factors for delirium?
Age
Dementia (often undetected)
Impaired activities of daily living
Immobility
Sensory impairment
Urinary cathetarisation
Malnutrition
Alcohol
Depression
How is delirium managed?
Anticipate
Modify risk factors if possible
Early diagnosis
Treat the underlying causes
Good nursing (single room, well lit, familiar staff/ family ideally)
Medication
Wait!
What is stigma in relation to mental health?
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)
What negative effects do stigma lead to?
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
What types of stigma are there?
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
