Introduction to Psychiatry Flashcards
What is the prevalence of post-stroke psychosis?
- Delusions 4.67% (95% CI 2.30% to 7.79%)
* Hallucinations 5.05% (95% CI 1.84% to 9.65%).
In which hemisphere strokes is post-stroke psychosis more common?
right (5:1)
What are the common delusional. themes in post-stroke psychosis?
- Persecutory
- Jealousy
- Environment
What is the overlap between physical illness and mental illness?
- 30% England long term condition
- 30% of people with a long term condition have mental health problem
- 20% of population have mental health problem
- 46% of people with a mental health problem have a long term condition
What are examples of physical illness associated with mental health symptoms?
- cardiovascular diseases 3x risk of depression and anxiety
- Diabetes 2x risk of depression
- Chronic obstructive pulmonary disease 10x risk of panic disorder
- Muscloskeletal disorders 2x risk of depression
What are examples of physical illness causing discrete mental illness?
- Thyrotoxicosis to anxiety, mania
- Thyroid deficiency to depression, dementia
- Cushings diseaseto depression
- Infections (syphilis, HIV)to Psychosis
- Cancer to depression
- Parkinson’s diseaseto depression, anxiety, dementia
What affects how people with chronic mental illness are at a greater risk of physical illness?
- Diet and exercise
- Smoking, alcohol and drugs
- Medication + side effects?
- People with chronic mental illness die 20 years younger than the general population.
What factors may affect timely diagnosis of physical disorders in people with mental illness?
- Timely diagnosis and treatment affected by
- Illness behaviour
- Diagnostic overshadowing
- Stigma
- Lack of resources
What is the prevalence of delirium?
- 20% acute hospital patients >65 on admission
- 20% more develop delirium after admission
- Overall prevalence 30% on wards, 80% in intensive care
- 50% undetected !!!!!
- 50% “hypoactive”
What is delirium?
- a psychiatric manifestation of a physical illness
- Sudden onset fluctuating confusion and inattention
- Also known as acute confusional state
Why is delirium important?
- Delays discharge
* Increases mortality
What are some causes of delirium?
•Infection (Urine, pneumonia, cellulitis, wound etc) •Change in environment (ITU, HDU, ward) •Medication (opiates, anticholinergics, steroids) •Alcohol withdrawal •Surgery •Pain -Liver/renal impairment -Hypoxia -Hyponatraemia -Stroke -Encephalitis -Constipation -Urine retention -Dehydration
What are some predisposing factors for delirium?
- Advanced age
- Dementia (often undetected)
- Impaired activities of daily living
- Immobility
- Sensory impairment (teeth, glasses, hearing aids)
- Urinary catheterization
- Malnutrition
- Alcohol
- Depression
What is the management of delirium?
- Anticipate
- Modify risk factors if possible
- Early diagnosis
- Treat the causes
- Good nursing;
- Single room, well lit, familiar staff/family (in an ideal world) - Medication
- Wait!
What is stigma?
refers to challenges faced by people with mental illness related to knowledge, attitudes, and behaviour of people they meet
Why is does stigma happen?
- Poor understanding of mental health
- Negative attitude
- Social exclusion
- Pervasive and widespread
- 75% people with mental illness experience stigma
What is interpersonal stigma?
- Direct effect on the individual
- Internalised discrimination
- Compounded by direct effects of illness
How is physical and mental health related?
- Physical illness may cause mental illness (e.g. Parkinsons, stoke, thyroid disease)
- Mental illness may.be present with physical symptoms (e.g. Depression, anxiety)
- Physical illness may present as mental illness (e.g. delirium, mania
What is an adjustment reaction?
- States of subjective distress and emotional disturbance, usually interfering with social functioning and performance
- arising in the period of adaptation to a significant life change or a stressful life event.….
- The manifestations vary and include depressed mood, anxiety or worry (or mixture of these), a feeling of inability to cope, plan ahead, or continue in the present situation, as well as some degree of disability in the performance of daily routine
What is an organic delusional disorder (symptoms started after stroke)?
- A disorder in which persistent or recurrent delusions dominate the clinical picture
- The delusions may be accompanied by hallucinations
- Some features suggestive of schizophrenia, such as bizarre hallucinations or thought disorder, may be present
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
Is there only one cause of delerium?
Often multiple medical causes
How stigma increase discrimination?
- Increases the disability caused by mental illness
2. Creates disadvantage with personal relationships, education, and work
What is interpersonal stigma?
- Family
- Friends
- Colleagues
What is structural stigma?
- Poor resources and funding
* Access to physical health care
