Medicine in Psychiatry Flashcards
Manu et al. 2012 found that what percentage of psychiatric inpatients are at some point transferred to a general hospital for medical care?
15%
What are the three most common causes of premature, sudden, and unexpected death in patients with mental illness?
suicides, accidents, and cardiovascular disorders
According to Ray et al. 2009, a large epidemiological study adjusted for comorbid somatic disorders, the incidence-rate ratios of sudden cardiac death were ____ for patients taking typical antipsychotics and ____ for patients taking atypicals.
1.99 & 2.26
Manu et al. 2011 examined causes of death in the psychiatric inpatient population, excluding suicide, trauma, homicide, and drug overdoses. What were the most common causes of death identified? (Just name a few).
acute coronary (15%), upper airway obstruction (both choking and OSA) (5%), pulmonary emboli (4%), thrombotic strokes (3%), heart failure (2%), aortic dissection (2%), myocarditis (2%), commotio cordis (1%) (sudden cardiac death due to chest impact).
Manu et al. 2011 examined causes of death in the psychiatric inpatient population, excluding suicide, trauma, homicide, and drug overdoses. In what percentage of the cases of sudden death was a cause unable to be identified?
52%
Name at least 3 items on the differential for “natural” sudden death.
Shock (hemorrhagic, septic, anaphylactic);
Intracranial hemorrhage;
Seizures;
Metabolic disturbance (acidosis, hypercalcemia);
Gas exchange failure (PE, non-cardiac pulmonary edema);
Arrhythmias;
Airway obstruction;
Pump failure (cardiac tamponade, cardiogenic shock, cardiac pulmonary edema);
(mnemonic = SISM GAAP “system gap”)
In the Atherosclerosis Risk in Communities study, the proportional hazard ratio of the association of baseline diabetes with sudden death over an average follow-up period of 12.4 years was____, independent of blood pressure, lipids, inflammation, hemostasis, and renal function (Kucharska-Newton et al. 2010).
3.77
What EKG findings are risk factors for torsades de pointes? (5 items)
QTc > 500 ms; abnormal T waves; large U waves; beat-to-beat QT variability; > 100 ms difference between longest and shortest QT interval
What electrolyte abnormalities are risk factors for torsades de pointes?
hypokalemia & hypomagnesemia
According to Rea at al. 2010, what two factors lead to the highest survival rates for patients with sudden cardiac arrest?
witnessed arrest + immediate CPR
What abnormal adduction of the vocal cords
during inspiration and, less commonly, during expiration, is an increasingly recognized disorder that usually manifests as refractory asthma? It is more prevalent among psychiatric patients and women
ages 30–50 years, and the prevalence is increasing among adolescents. Symptoms include wheezing, stridor, and shortness of breath.
vocal cord dysfunction
What condition is an extrapyramidal adverse reaction to neuroleptics, including antiemetic phenothiazines and metoclopramide? The symptoms usually develop within 7 days of initiation of the neuroleptic
medication and include dysphonia, respiratory distress, and stridor.
neuroleptic-induced acute laryngeal dystonia (NALD)
What are some pharmacological treatments for NALD (neuroleptic-induced acute laryngeal dystonia)?
diphenhydramine (Benadryl), benztropine, benzodiazepines, and barbiturates (4 Bs)
What complication of treatment with ACE-inhibitors can result in upper-airway obstruction, to be treated with epinephrine, corticosteroids, and antihistamines?
angioedema
An elevated level of serum _____ (a fibrin degradation product) is a sensitive but not specific marker of thrombosis and raises clinical suspicion of PE.
D-dimer
