mental disorders and physical health Flashcards
what is adjustment disorder
-Recent psychosocial stressors (illness and move into care)
-Mood changes and focusing on stressors
-Typically resolves after 6 months
-Psychotic symptoms typically not seen
what is Psychotic depression
-Recent psychosocial stressors
-Older age and chronic medical conditions are risk factors
-No other core features of depression (anergia, anhedonia) or biological symptoms reported
-Paranoid psychosis rare. Typically a mood congruent psychosis is seen (delusions of nihlism, guilt, Cotard’s syndrome)
-Visual hallucinations uncommon
what is Behavioural and psychological symptoms of dementia (BPSD)
-recent stoke
-Delusions and hallucinations
-Ongoing vascular risk factors and advancing age (main risk factor for dementia)
-Normal score on MoCA
-No cognitive concerns raised by carers
-BPSD typically a feature of more advanced disease
what is post stroke psychosis- where it occurs, typical symptoms and management
-commonly after right MCA lesion affecting frontal and temporal regions
-delusion
-auditory hallucinations (followed by visual)
managemnt:
-some response to antipsychotic
antipsychotic use in those with dementia increases the risk of what?
stroke
common type of delusion in post stroke psychosis
persecutory or jealous type (Othello’s syndrome)
physical illness causing mental illness -addison’s disease
depression, poor concentration, irritability
physical illness causing mental illness -hyperglycaemia
depression, anxiety
physical illness causing mental illness -hyperthyroidism ✯
anxiety, mania
physical illness causing mental illness -hypothyroidism✯
depression, cognitive impairment
physical illness causing mental illness - cushing’s syndrome✯
depression
physical illness causing mental illness -HIV
psychosis, dementia
physical illness causing mental illness -SLE
depression
physical illness causing mental illness - cancer
depression
physical illness causing mental illness -parkinson’s disease✯
depression , anxiety, dementia, psychosis
physical illness causing mental illness -phaeochromocytoma✯
anxiety
physical illness causing mental illness -dementia✯
psychosis, aggression/violence, depression, anxiety
physical illness causing mental illness - Huntington’s disease✯
psychosis, aggression/violence, cognitive impairment, depression, anxiety
medication adverse effects- dopamine agonist✯
psychosis
medication adverse effects-L-dopa
psychosis, delirium, anxiety, depression
medication adverse effects- steroids (prednisolone) ✯
depression, mania, psychosis, anxiety
medication adverse effects-isoniazid (Tb ab)
mania, psychosis
medication adverse effects-anticholinergics✯
delirium, anxiety, psychosis
medication adverse effects-isotretinoin (roaccutane)
depression
medication adverse effects-digoxin
depression, psychosis
medication adverse effects- Interferon alpha
depression, mania, psychosis
what is the mortality gap
people with chronic mental illness are at greater risk of all cause mortality
cause of mortality gap/impact on physical health with those with mental illness
-med adverse effects (ie. weight gain, sedation)
-increase smoking, alcohol rate
-poor diet and exercise
-chaotic life style and low socioeconomic status
management of mortality gap/impact on physical health with those with mental illness
-choose medication that minimise impact on physical health
-monitor cardiometabolic factors (ie MBI/HbA1c)
-smoking cessation
-dietary advice
-drugs and alcohol support service
what is delirium
acute confusion state and neuropsychiatric manifestation of physical illness/injury/intervention
can be considered as ‘acute brain failure’ compared to ‘chronic brain failure’ - dementia
3 types of delirium
hyperactive- agitation, hallucination, inappropriate behaviour
hypoactive-lethargy, reduced concentration, reduced alertness, reduced oral intake
mixed-combo of above
risk factor of delirium
older people
frail
poor nutrition
cognitive impairment etc
common cause of delirium
Physical illness or injury
(e.g. infection, constipation, urinary retention, electrolyte disturbance, pain, acute vascular events, dehydration
pathological cause of delirium
poorly understood and likely multi-factorial
Delirium involves various brain processes like inflammation, vascular dysfunction, altered metabolism, neurotransmitter imbalance, and impaired connectivity
delirium management
- address modifiable risk factors
2.optimise co-morbidities treatment
3.treat underlying cause
4.re-orientation strategy
5.normalise sleep-wake cycle
- maintain safe mobility to avoid falls
what to do in challenging behaviours in delirium
-verbal and non-verbal de-escalation technique
-in extremis- short term pharmacological interventions (ie. low dose Haloperidol [0.5mg] for<7days)
what affects diagnosis of physical disorders in people with mental illness
-illness behaviour (ie. poor insight/mistrust in others, chaotic lifestyle)
-diagnostic overshadowing (misattribution of physical symptoms to psychiatric symptoms)
-lack of resources/access to service (low socio-economic status=RF for mental disorder development)
