Mental disorders and physical health Flashcards
What is psychosis?
Difficulty perceiving and interpreting reality
What are the 7 parts of a mental state examination?
(ABSMPTIC - A Bear Stood Menacingly Preparing To Instigate Conflict)
Appearance+Behaviour,
Speech,
Mood,
Perceptions,
Thought (content, form, possession),
Insight,
Cognition
How can you assess A+B?
Dressed properly, Distracted when talking (hallucinations?), Facial expressions, Eye contact, weight, echophenomena (mimic actions)
How can you assess speech?
Speech rate, rhythm (prosody), volume, comprehension
How can you assess mood?
Non-verbal cues, anxiety, Affect (expression of emotion) - blunted (difficulty expressing)
How can you assess perceptions?
Objective response to hallucination -> hallucination or pseudohallucination // command hallucination (risk to people)
How can you assess thought form?
Processing and organisation of thought abnormalities - loose associations (random topic changes)
How can you assess thought content?
Delusions (including persecutory - ppl want to hurt them), Obsessions
How can you assess thought possession?
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)
How can you assess insight?
Patient’s understanding if they have a mental health problem and they are experiencing abnormal things // Judgement - can they make logical reasonings with information
How can you assess cognition?
Orientation of time/place/person, Attention span and Concentration, Short-term memory
What is adjustment disorder and how does it relate to psychosis?
Recent life changing events increase stress and low mood (moving into carehome, bereavement), however psychotic symptoms rare & resolve in 6 months
What is psychotic depression, and what type of psychosis do you see?
Depression from older age and chronic medical conditions // congruent psychosis (nihlism, guilt) but not paranoia and hallucinations
What is post-stroke psychosis and how prevalent is it?
Neuropsychiatric symptoms like delusions and auditory hallucinations following stroke, 30% prevalence
What lesions does post-stroke psychosis usually occur from?
Right sided middle cerebral artery - frontal and temporal lobes
What is the relationship between physical and mental illness called?
Interplay
What are the three groups of things that can lead to interplay?
Conditions that require long term medication // Physical Illnesses directly causing // Medication Adverse Effects
What are three examples of conditions that require long-term medication that can lead to mental disorders?
CVD, Chronic MSK disorders, Diabetes (depression)
What are some physical conditions that can cause mental health disorders?
Hypothyroidism, Cushing’s, Cancer (depression)
What are some medications that can cause adverse effects to mental health?
Dopamine agonists (psychosis), - treatment of prolactinoma and parkinson’s
Corticosteroids (depression),
Anticholinergics (delirium)
How can severe mental disorders affect life-expectancy?
Can be reduced up to 10-25 years
What are some management techniques to help reduce the impact of other factors on mental illness?
Choose medication with fewer adverse effects, smoking and alcohol cessation, dietary advice
What is the definition of delusion?
Fixed, false belief that is not understandable considering the person’s sociocultural upbringing
Memory clinic investigation
ACE III - Addenbrooke’s cognitive examination
What are the differences between delirium and psychosis?
Delirium - mental confusion from being medically unwell, psychosis is loose perception with reality ->
delirium has mainly visual hallucinations, psychosis mainly auditory hallucinations
Delirium
acute brain failure, confusional state with neuropsychiatric manifestation of physical illness
associated with increased mortality and delays in discharge
Hyperactive delirium
agitation, hallucination, inappropriate behaviour
Hypoactive delirium
lethargy, reduced concentration, reduced alertness and oral intake
mixed delirium
combo of hypo and hyperactive delirium
What are some predisposing factors for delirium?
Age, dementia, sensory impairment, alcohol, malnutrition
What are the critical illnesses that can usually cause delirium?
Infection, Change in environment (ICU), medication, alcohol withdrawal, surgery, hyponatraemia
Pathophysiology of delirium
poorly understood and highly multi factorial. No single pathophysiology
How do you manage delirium?
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
Stigma
barrier to accessign all aspects of care
risk factor for patients experiencing abuse, rejection and isolation
contributes to difficulties in employment
Why might there be a delay in diagnosis of mental illness?
Stigma (affects 75%), poor insight, mistrust
Resources, low socio-economic status
Diagnostic Overshadowing (misattribute symptoms to physical condition)
