Medical causes of psychiatric symptoms Flashcards
What is the importance of excluding a general medical condition as the cause of psychiatric sx
- Is a requirement of satisfying DSM criteria.
- Symptoms won’t resolve because you haven’t treated the cause.
- Underlying medical condition may have high morbidity and/or a poor prognosis.
- Underlying medical condition may be life-threatening if not treated promptly.
- Some GMC are potentially curable and/or manageable.
- Psychiatric disease impacts adherence.
Name standard investigations that could be done when a pt presents with psychiatric sx
● Vitals ● Bloods (FBC, U+E, WCC, Hb, Glucose) ● Syphilis serology (RPR or VDRL) ● HIV Test ● Thyroid Function Tests ● Urine toxicology
What other examinations could be done if there are indications from history and examination that there might be a medical cause
● X- ray and CT scan – suspected head injury, tumours
● LP - CSF examination to exclude meningitis
● MRI - vascular dementia
● Immunological Studies - ANA for SLE
● Blood gases
Describe the ABCDP3 approach to psychiatric symptoms
● ‘A’ is for Affective (mood) and Anxiety disorders.
● ‘B’ is for the Behavioural problems which often arise from, and accompany, psychiatric disorders.
● ‘C’ is for Cognition - there are discrete disorders of cognition, and cognitive changes often occur in mental
illness.
● ‘D’ is for Drugs. Knowing about drugs of abuse is important in psychiatry and prescribed medications can also
often have side-effects which in themselves can cause symptoms.
● ‘P’ is for ‘Psychosis’, ‘Personality’ and ‘Physical’.
● Psychosis is a cluster of symptoms and occurs in a large number of psychiatric disorders. NB to distinguish
between psychosis and delirium.
● Personality refers to personality disorders, and to personality changes which can occur as a result of
neuro-psychiatric illness.
● Physical: every psychiatric patient must have a physical examination, and special investigations, as warranted,
to exclude underlying physical disease.
What is anxiety
A feeling of apprehension and fear, characterized by physical symptoms such as palpitations, sweating, and feeling of stress
Pathological anxiety criteria
- Autonomy- minimal or recognisable trigger
- Intensity- more than the individual can bear
- Duration- persistent; > 6 months
- Behavioural changes e.g. withdrawal
Sx of anxiety
- Chest pain
- Palpitations
- Dyspnoea
- Dizziness
- Nausea
- Numbness or tingling sensations
Medical causes of anxiety
trauma- head injury vascular- hypertension, heart disease autoimmune- diabetes 1, grave’s disease metabolic- porphyria endocrine - hyperthyroidism
Pathophysiology of hyperthyroidism
● Increased production of thyroid hormone
● The thyroid gland’s main function is to regulate the
metabolic rate
● Commonest cause is Graves’ Disease
- Autoimmune disease where IgG antibodies bind to the thyrotropin receptor
- Stimulates thyroid hormone release
Common signs and sx of hyperthyroidism
● Nervousness/anxiety ● Sensitivity to heat ● Bulging eyeballs & goitre (swelling in the neck) ● Loss of weight ● Palpitations ● Tremor ● Insomnia ● Thinning skin ● Fine, brittle hair
Psychiatric sx of hyperthyroidism
● Anxiety ● Labile mood ● Irritability ● Insomnia ● Delusions and hallucinations
Treatment of hyperthyroidism
● Radioactive iodine
● Anti-thyroid medication
● Beta-blocker
What is the affect of the patient
Affect is the outward expression of feelings and emotion. Affect can be a tone of voice, a smile, a frown, a laugh,
a smirk, a tear, pressed lips, a wrinkled forehead, a scrunched nose, furrowed eyebrows, or an eye gaze. It’s
really any facial expression or body movement that indicates emotion.
Different types of affects and explain each
The different types of affect are:
● Restricted or Limited Affect: This denotes a limited range of affects that a person can demonstrate.
When speaking of something that they are excited about, they may not outwardly smile or become
wide-eyed, affects that usually indicate excitement.
● Blunted Affect: This is when restricted or limited affect becomes more severe and when the expression of
emotion becomes even more absent. For example, someone may react to news that a death in the family
has just occurred with a monotonous tone or an extremely apathetic appearance.
● Flat Affect: This is a restriction of all expressions of emotion. A person with flat affect will not express
emotion through facial expressions or body movement.
● Labile Affect: This is the affect that is unstable or out of proportion to the situation. For example a
therapist will say something mildly funny and the reaction of the patient is uncontrollable and boisterous
laughter for 20 seconds.
● Reactive Affect: Normal, congruent affect
List affective disorders
● Depression ● Postpartum Depression ● Atypical Depression ● Seasonal Affective Disorder (SAD) ● Bipolar Disorder ● Dysthymia and Cyclothymia ● Generalised Anxiety Disorder ● Panic Disorder ● Phobias including Agoraphobia ● Obsessive Compulsive Disorder (OCD) ● Post-traumatic stress disorder (PTSD)
List infective causes of affect change
● Malaria ● Typhoid Fever ● Tuberculosis ● HIV/AIDS ● Candidiasis ● Neurosyphilis
List nutritional deficiencies causing affect change
● Folate
● Vitamin B12, B1 (Thiamine), B6
● Anaemia
list endocrinopathies that causes affect changes
● Hypothyroidism ● Cushing’s syndrome ● Diabetes mellitus and hypoglycemia ● Hypopituitarism
Drugs causing affect changes
● Cardiovascular: methyldopa, beta-blockers, diuretics, digoxin ● Endocrine: steroids, oral contraceptives ● Alcohol abuse ● Butyrophenones ● Others: chloroquine, mefloquine, ampicillin
