medical illnesses with psychiatric symptoms

Question 1

medical or mental

Answer 1

mind and body not dualistics -> intertwined
holistic client -> everything affects one another
lots of stress -> aggression, dep, anx, anger, sus, psychosis
illness with psych manifestations

Question 2

medical mimics

Answer 2

d/o that present with psych s directly result from underlying med condition

Question 3

dx overshadow

Answer 3

attribute s of phys illness to mental illness
mis dx leads to unnecessary or harmful tm, delay in tm, increased stay and $

Question 4

medial mimics associated with mood d/o

Answer 4

similar s/s as dep
cushisngs, dementia, fibromyalgia/chronic fatigue s, hyper/hypothy, sleep apnea, mononucleosis

Question 5

med illnesses with psychotic s

Answer 5

cushings, hypoer/hypothy
also chemo
estrogen: oral contraceptives, hormone, replacement, early menopause

Question 6

psychotic d/o d/t another med condition

Answer 6

“med condition” = fil in the blank
s/s:
hallucinations, delusions, d/o speech and thought patterns
s of med condition not associated with mental d/o that may cause psychosis -> schizophrenia spectrum d/o
may be temporary and brief or long term, persist after med condition resolved

Question 7

MI associated with anx d/o

Answer 7

cushings, hyper/hypo, hypervent, hypoxia
always check TSH, T3, T4

Question 8

psych SE from pharm

Answer 8

not normal med outcome, not therapeutic
often resemble spont psych syndromes
occur with usual doses, intox, w/d
range from short lasting anx -> severe confusion
suicide

Question 9

PSE rf

Answer 9

polypharm, high dose, route of admin, ast admin, narrow therapeutic index, hepatic insufficiency, slow met, met condition, augmented perm of BBB (meningitis, porphyria), v young or elder, post partum, stress, ICU

Question 10

meds with common psych SE

Answer 10

most resolve by managing/stopping med
CNS active: anticonvulsants, antidep, antipsych, psychostim, sedative hypnotics, dopaminergic antiparkinson
abuse cough and cold meds
antihtn, oral contraceptives, steroids, chemo, benzo, barbiturates, h2 blockers (esp when stopped abruptly)
steroids

Question 11

hallmark rf of meds mimic

Answer 11

1+ ft atypical for psych s:
normal F prior to sudden onset of mental s
late onset of initial presentation (unusual age - F > M; usually late adolescence/early adult)
known underlying med condition
atypical presentation of specific psych dx
disturbance of gait, balance, both
usual, olfactory, tactile hallucinations
illicit or recent substance use

Question 12

commonly abused substances

Answer 12

OH, opioid, amphetamines (ecstasy, meth), cocaine , benzos, barbiturates, steroids, LSD

Question 13

high R for med mimic

Answer 13

no personal/fam hx psych illness, fam concern, med use/change, abn VS or sig abn on phys assessment, wax and wane mental status or abn mental state findings , disorient with clouded consciousness, recent mem loss, hx head injury, tm resistance, or unusual response to tm (worse after anti psych or anxiolytic)

Question 14

dsm5

Answer 14

mental disturbance cause by physiologic effects of another med condition or effects of drug/med

Question 15

high R individuals

Answer 15

elder, hx substance abuse, no history of psych illness, pre existing med illness, lower socioeconomic status

Question 16

lab and met assess

Answer 16

pulse ox, therapeutic drug level, BAC, UA and UDS, thyroid F tests, erythrocyte sedimentation rate or CRP, screen for syphilis, Lyme, lupus, demyelinating d/o, AIDS/HIV, ct, lumbar puncture, blood and urine culture, B12 or thiamine def, electrolytes cbc

Question 17

nc

Answer 17

holistic, be aware of med mimics, emotional dimensions of med conditions may be overlooked, provide reassurance and support, be sensitive to emotional experiences
accurate and thorough hx and phys assessment, ask about substance use, review Rx and otc and alternative and recent changes, monitor labs and report abn, question F about eating habits and diet pills