Mental disorders and physical health

Question 1

What is psychosis?

Answer 1

Difficulty perceiving and interpreting reality

Question 2

What are the 7 parts of a mental state examination?
(ABSMPTIC - A Bear Stood Menacingly Preparing To Instigate Conflict)

Answer 2

Appearance+Behaviour,
Speech,
Mood,
Perceptions,
Thought (content, form, possession),
Insight,
Cognition

Question 3

How can you assess A+B?

Answer 3

Dressed properly, Distracted when talking (hallucinations?), Facial expressions, Eye contact, weight, echophenomena (mimic actions)

Question 4

How can you assess speech?

Answer 4

Speech rate, rhythm (prosody), volume, comprehension

Question 5

How can you assess mood?

Answer 5

Non-verbal cues, anxiety, Affect (expression of emotion) - blunted (difficulty expressing)

Question 6

How can you assess perceptions?

Answer 6

Objective response to hallucination -> hallucination or pseudohallucination // command hallucination (risk to people)

Question 7

How can you assess thought form?

Answer 7

Processing and organisation of thought abnormalities - loose associations (random topic changes)

Question 8

How can you assess thought content?

Answer 8

Delusions (including persecutory - ppl want to hurt them), Obsessions

Question 9

How can you assess thought possession?

Answer 9

Thought insertion (belief that thoughts are inserted into their mind)
Thought withdrawal (belief that thoughts can be removed from their mind)
Thought broadcasting (belief others can hear their thoughts)

Question 10

How can you assess insight?

Answer 10

Patient’s understanding if they have a mental health problem and they are experiencing abnormal things // Judgement - can they make logical reasonings with information

Question 11

How can you assess cognition?

Answer 11

Orientation of time/place/person, Attention span and Concentration, Short-term memory

Question 12

What is adjustment disorder and how does it relate to psychosis?

Answer 12

Recent life changing events increase stress and low mood (moving into carehome, bereavement), however psychotic symptoms rare & resolve in 6 months

Question 13

What is psychotic depression, and what type of psychosis do you see?

Answer 13

Depression from older age and chronic medical conditions // congruent psychosis (nihlism, guilt) but not paranoia and hallucinations

Question 14

What is post-stroke psychosis and how prevalent is it?

Answer 14

Neuropsychiatric symptoms like delusions and auditory hallucinations following stroke, 30% prevalence

Question 15

What lesions does post-stroke psychosis usually occur from?

Answer 15

Right sided middle cerebral artery - frontal and temporal lobes

Question 16

What is the relationship between physical and mental illness called?

Answer 16

Interplay

Question 17

What are the three groups of things that can lead to interplay?

Answer 17

Conditions that require long term medication // Physical Illnesses directly causing // Medication Adverse Effects

Question 18

What are three examples of conditions that require long-term medication that can lead to mental disorders?

Answer 18

CVD, Chronic MSK disorders, Diabetes (depression)

Question 19

What are some physical conditions that can cause mental health disorders?

Answer 19

Hypothyroidism, Cushing’s, Cancer (depression)

Question 20

What are some medications that can cause adverse effects to mental health?

Answer 20

Dopamine agonists (psychosis), - treatment of prolactinoma and parkinson’s
Corticosteroids (depression),
Anticholinergics (delirium)

Question 21

How can severe mental disorders affect life-expectancy?

Answer 21

Can be reduced up to 10-25 years

Question 22

What are some management techniques to help reduce the impact of other factors on mental illness?

Answer 22

Choose medication with fewer adverse effects, smoking and alcohol cessation, dietary advice

Question 23

What is the definition of delusion?

Answer 23

Fixed, false belief that is not understandable considering the person’s sociocultural upbringing

Question 24

Memory clinic investigation

Answer 24

ACE III - Addenbrooke’s cognitive examination

Question 25

What are the differences between delirium and psychosis?

Answer 25

Delirium - mental confusion from being medically unwell, psychosis is loose perception with reality ->
delirium has mainly visual hallucinations, psychosis mainly auditory hallucinations

Question 26

Delirium

Answer 26

acute brain failure, confusional state with neuropsychiatric manifestation of physical illness
associated with increased mortality and delays in discharge

Question 27

Hyperactive delirium

Answer 27

agitation, hallucination, inappropriate behaviour

Question 28

Hypoactive delirium

Answer 28

lethargy, reduced concentration, reduced alertness and oral intake

Question 29

mixed delirium

Answer 29

combo of hypo and hyperactive delirium

Question 30

What are some predisposing factors for delirium?

Answer 30

Age, dementia, sensory impairment, alcohol, malnutrition

Question 31

What are the critical illnesses that can usually cause delirium?

Answer 31

Infection, Change in environment (ICU), medication, alcohol withdrawal, surgery, hyponatraemia

Question 32

Pathophysiology of delirium

Answer 32

poorly understood and highly multi factorial. No single pathophysiology

Question 33

How do you manage delirium?

Answer 33

optimise treatment of underlying co-morbidities/causes
re-orientation strategies, keep ppl in familiar environments
normalise sleep-wake cycle, discourage daytime napping
maintain safe mobility to avoid falls
reduce polypharmacy, visual and hearing aids

Question 34

Stigma

Answer 34

barrier to accessign all aspects of care
risk factor for patients experiencing abuse, rejection and isolation
contributes to difficulties in employment

Question 35

Why might there be a delay in diagnosis of mental illness?

Answer 35

Stigma (affects 75%), poor insight, mistrust
Resources, low socio-economic status
Diagnostic Overshadowing (misattribute symptoms to physical condition)