liason psych day 1 Flashcards
name 5 psych disorders that are classified as anxiety disorders
1 - PTSD 2 - panic disorder 3 - OCD 4 - Generalised anxiety disorder 5 - phobias
name psych disorders that are classified as mood disorders
1- depression (there are subclassificiatons eg dysthymic disorder)
2 - bipolar disorders (several subclassificaitons)
gross breakdown of symptoms of depression
1 - core
2 - psychological
3 - somatic
3 core symptoms of depression
1 - low mood with diurnal variation
2 - loss of interest and anhedonia
3 - fatigueability
4 psychological symptoms of depression
1 - poor concentration
2 - low self esteem
3 - guilt
4 - pessimism
3 somatic symptoms of depression
1 - sleep disturbance esp early morning waking
2 - anorexia or weight loss
3 - loss of libido
how to ask a patient about mood - stock phrases
“Have you been feeling sad or tearful?”
“Have there been things you have been able to enjoy over the last couple of weeks?”
“Have you found ways of keeping your spirits up while you have been in hospital?” [visits/phone calls from relatives, watching TV, reading etc]
Do you ever wake very early and are not able to get back to sleep?”
give some psychological symptoms of anxiety
Psychological Feeling of fear or “impending doom” Restlessness, dizziness, faintness Exaggerated startle response Poor concentration Irritability Insomnia and night terrors Depersonalisation and Derealisation ‘Globus hystericus’
give some physical symptoms of anxiety
Physical
Cardio: Tachycardia, Palpitations, Chest Pain
GI: Dry Mouth, Globus, Nausea, Abdo Pain, Loose stools
Resp: Shortness of breath, chest tightness
GU: Frequency, Erectile Dysfunction, Amenorrhoea Neuro: tremor, headache, muscle pains, paraesthesia
NB. These arise from autonomic arousal, hyperventilation and muscle tension
how to ask a patient about anxiety - stock phrases
“Have you been feeling anxious?”
“Could you tell me more about those worries?”
“What coping techniques do you have for when you feel under stress, or upset?”
asking about self harm
Sometimes if people are feeling particularly stressed, worried or low, they can have thoughts about harming themselves, or ending their lives. Have this ever happened to you?”
“If it did, who would you be able to talk to this about?”
prevalence of mental disorders in hospitals
•>1/4 hospital patients have a mental disorder
–2/3 of hospital beds occupied by older people, of which 60% have, or will develop, a mental health condition during their stay
–Most commonly dementia, delirium, depression*
effect of physical ill health on mental ill health
~1/4 of people with physical health problems develop psychological problems as a consequence of the stress of their physical problems:
–Loss of identity/role
–Loss of function
–Change of lifestyle/restrictions/disability
–Dependency on others
–Impaired capacity to maintain relationships
–Deterioration in health/threat to life
–Impact on body image, self-esteem
5 factors that influence the mental response to illness
•Illness perception
•Coping strategies
•Individual factors/personality
•Type of illness – increased levels of psychiatric morbidity with
–Increased levels of pain, advanced disease, high levels of disability
–Neurological disorders directly affecting the brain
•Therapeutic setting
*Guthrie E & Nayak (2012). Psychological reaction to physical illness
what is adjustment disorder
- Onset of symptoms must occur within 1 month of exposure to an identifiable psychosocial stressor, not of an unusual or catastrophic type
- Symptoms or behavioural disturbance may be a depressed or anxiety reaction or conduct disorder (in children)
- Except in prolonged depressive reaction, the symptoms do not persist for > 6 months after the cessation of the stress or its consequences
risk of mental health issues in those with other chronic medical conditions
- “People with diabetes, hypertension and coronary artery disease have double the rate of depression compared with the general population. They are also at risk of developing vascular dementia.
- Those with chronic obstructive pulmonary disease, cerebro-vascular disease and other chronic conditions have triple the rate of depression.
- People with two or more chronic physical conditions are 7 times more likely to have mental health problems.”
Kubler-Ross 5 stages of grief
The Kübler-Ross model, or the five stages of grief, is a series of emotional stages experienced when faced with impending death or death of someone. The five stages are denial, anger, bargaining, depression and acceptance.
The model was first introduced by American Psychiatrist Elisabeth Kübler-Ross in her 1969 book, On Death and Dying, and was inspired by her work with terminally ill patients
problems of comorbid mental health issues in those with T2DM
Prevalence of depressive disorders is ~9% (around two fold higher than in healthy controls)
•Comorbid depression associated with:
–poorer glycaemic control;
–diabetes complications;
–and increased risk of death*
effect of schizophrenia and bipolar disorder on longevity
•People with schizophrenia and bipolar disorder die on average 16 to 25 years sooner than the general population.*
•They have higher rates of –Respiratory disease –Cardiovascular disease –Infectious disease –Obesity, abnormal lipid levels and diabetes**
effect of SSRIs on bleeding
Serotonin released from platelets in response to vascular injury promotes vasoconstriction and morphological changes in platelets that leads to aggregation.
SSRIs inhibit the serotonin transporter which is responsible for the uptake of serotonin in to platelets
SSRIs significantly increase the risk of GI bleeds
LOTS OF ANTIPSYCHOTICS HAVE LISTS OF PHYSIOLOGICAL SIDE EFFECTS THAT CAN BE SERIOUS.
why might there be such a high prevalence of psychiatric disorders in hospital
High prevalence of psychiatric disorders in the acute hospital setting. This can be due to:
–Relapse of primary mental illness
–New onset mental illness
–Organic illness
•Comorbid mental disorder and physical illness increase morbidity and mortality
diagnosis of a learning disability
DSM V uses a generic IQ<70 indicating LD but level is based on limitations in adaptive functioning
criteria:
- Impaired intellectual function
- Impaired adaptive function
- Arising in developmental period
5 causes of learning disabilities
- Idiopathic
- Genetic
- Substance misuse
- Perinatal problems
- Environmental
what is down’s syndrome
Trisomy 21 but also translocation & mosaics
•1/650-1/1000 Live births, maternal age related, common in males
