liaison psychiatry Flashcards
what is liaison psychiatry
link between general medicine and psychiatry in hospital setting
what is delirium?
an acute confusional state
what disturbances are seen in delirium?
- consciousness and attention
- perception
- thinking
- memory
- psychomotor behaviour
- emotion
- sleep-wake cycle
duration of delirium
variable
variable severity
onset of delirium
acute, sudden
what is the core feature of delirium?
inattention
delirium and future cognitive decline?
increases risk
how does delirium affect outcomes?
worsens and increases mortality rates
RFs for delirium?
- elderly
- previous
- dementia
- pain
- constipation
- infection
- electrolytes
- medication
- sensory impairment
causes of delirium?
I WATCH DEATH
Infection Withdrawal Acute metabolic syndrome Trauma CNS pathology Hypoxia Deficiency - thiamine, anoxia Endocrine - hypo/erthyroid, cushings, addisons Acute vascular/MI Toxins/drugs - CO, steroids, opiates, digoxin Heavy metals - lead, mercury
workup for delirium
- med = psych hx
- collateral hx
- MMSE
- pex
- ix
ix for delirium?
Basically everything
don’t forget:
TFTs B12 folate VDRL septic screen drug screen EEG LP
assessment scales for delirium?
- MMSE
- AMTS
- AMT-4
- CAM
attention assessments
attention assessments for delirium
MBT - months of the year backwards
days of the week backwards
count from 20 to 1
SAVEAHAART - >2 errors = fail, squeeze hand at A
mangt delirium?
tx UC
environmental mangt delirium?
- psychoeducation
- family involvement
- reorientate frequently
- environmental cues - clock/calendar
- lighting for time of day
- give glasses, hearing aid
- mobilise and ADLs
- 1:1 nursing
- stop unnecessary meds
- treat pain, constipation, dehydration etc
- meds - not 1st line
meds in delirium?
antipsychotics may reduce duration
not 1st line
indications for meds in delirium?
- patient distress
- risk harm to patient/others
- v disturbed sleep
- significant behavioural prob
what is a conversion disorder?
thoughts or memories that are unacceptable are repressed and converted into physical symptoms
what is a dissociative disorder?
condition involving breakdown of memory, awareness, identity or perception - defense mechanism that is pathological and involuntary
examples of dissociative disorder?
- dissociative amnesia
- dissociative fugue
- trance and possession disorder
- dissociative motor disorders - paralysis, aphonia
- dissociative convulsions
- dissociative anaesthesia and sensory loss
- other eg ganser syndrome
DSM vs ICD 10 dissociative and conversion
DSM - conversion = motor or sensory deficit, diss = function of consciousess disturbance
ICD10 - use both synonymously, prefer diss.
cause of DDs?
- psychogenic
2. traumatic events
what do sufferers hope to gain from DDs?
nothing
onset and offset of DDs?
sudden
how long do DDs last?
weeks - months max
features of dissociative convulsions?
- non epileptic but commonly in those with epilepsy
- usually an audience
- no injury when fall
- don’t bite tongue or incontinent
- general shaking, not tonic clonic
- no post ictal confusion or raised prolactin
- usually a stressor
how are DDs diagnosed?
- clinically inconsistent signs
- exclude organic dz
- demonstrate function thought to be absent
- convincing psych explanation
tx DDs?
- supportive psychotherapy
- explain initially organic sx but now due to maladaptive response
- physio
- tx comorbid psych prob
px DDs?
if acute conversion - good esp if obvious cause
poor outcomes in long lasting and established sx
what are the kinds of medically unexplained symptoms?
- somatoform disorders
2. simulated disorders
how common are MUS?
1/3 of symptoms in PC
50% in secondary care
what are the somatoform disorders (ICD10)
- somatisation
- hypochondriacal
- somatoform pain disorder
what is somatisation
- experience bodily symptoms with no physical cause and assumed psych cause
what is hypochondriasis?
- believing one has an illness DESPITE evidence to contrary
- eg an overvalued idea that goes to delusional intensity
so what’s the diff between hypochondriasis and somatisation?
preoccupation with symptoms vs preoccupied with disorder
other features of somatoform disorders?
impaired functioning
history of stressful life events or psych trauma
somatisation affects ___________ organ system
multiple
when does somatisation present?
how long do symptoms have to last in somatisation?
2 years
prevalence of somatisation disorder
0.13%
gender in somatisation?
F>M
course of somatisation?
chronic relapsing
management principles of somatisation disorder?
- must trust doc
- consistency
- minimise investigations
- focus on new symptoms
- be clear about findings
- psych - meds for comorbid and CT
- focus on function not symptoms
how long does hypochondriasis have to last?
at least 6 months
is hypochondriasis delusional
NO
prevalence of hypochondriasis?
0.8-5%
course of hypochondriasis
chronic relapsing
comorbidities common
cause hypochondriasis
unknown
mx of hypochondriasis?
SSRI high dose
CBT
what are the consciously simulated disorders?
malingering
factitious - munchausens +/- by proxy
Malingering what is it?
patient conscious of gain and producing symptoms
Factitious disorder features?
- conscious production of symptoms with intent to deceive but UNCONSCIOUS OF GAIN
- wants to be in the sick role
- dependent personality
- munchausens
