Mental Disorders And Physical Health Flashcards
Post stroke psychosis
Most commonly seen in right middle cerebral artery lesions affecting frontal and temporal regions
Delusions are the most commonly reported psychotic symptoms. Most delusions of a persecutory or jealous type (orthelloas syndrome). They are fixed false beliefs not understandable within persons sociocultural setting
What are the most common perceptual abnormalities of post stroke psychosis
Auditory hallucinations followed by visual
Management of post stroke psychosis
No controlled studies but some respond to antipsychotic medications
Increased risk of stroke with antipsychotics use in those with dementia
Physical health in those with mental illness multifactorial cause
Multifactorial cause: Medication adverse effects (eg weight gain,dylipidaemia,insulin insensitivity,hypertension,sedation).
Increased rates of smoking,illicit substance use and alcohol intake
Poor diet,dental hygiene,low levels of exercise
Chaotic lifestyle and low socioeconomic status.
Physical health in those with mental illness management
Choose medication that minimizes impact on physical health eg weight gain,antidepressants
Monitor cardio metabolic factors
Ensured registration with a GP and dental practice
Dietary advice ,smoking cessation
Drug and alcohol support services
Delirium examinations
Pre appointment bloods check for anaemia
Mental state examination consider pseudo dementia if depressed
Addenbrookes cognitive examination (ACEIII) shows dementia
Delirium mri brain
Temporo parietal cortical atrophy
Mesial temporal lobe atrophy
Mild small vessel disease
Delirium classifications
Hyperactive-Agitation,hallucinations,inappropriate behavior
Hypoactive-lethargy,reduced concentration,reduced alertness,reduced oral intake
Mixed-combo of both
Delirium aetiology
Common causes-physical illness or injury eg (infection,constipation,urinary retention,electrolyte imbalance,pain)
Pathophysiology-illness increases cortisol levels and cerebral hypoxia which decreases acetylcholine and dysfunction of hippocampal and neocortical areas. Neuroinflammation,neurovascular dysfunction,altered brain metabolism and neurotransmitter imbalance can cause it too
Delirium management
Anticipate and address any modifiable risk factors
Optimize treatment of underlying co morbidities
Treat underlying cause (eg uti,physical injury,dehydration,electrolyte disturbances)
Reorientation strategy (use clocks,familiar environments,remind of name and current location)
Normalize sleep wake cycle
In extremis give short term pharmacological interventions eg low dose haloperidol for less than 7 days
Stigma
3/4 people with mental health experience stigma
Rates higher in BAME communities
Stigma is a barrier to all aspects of care knclduinf difficulties in employment,
What factors affect diagnosis of physical disorders in people with mental illness
Illness behavior eg poor insight,mistrust of others,chaotic lifestyle
Diagnostic overshadowing
Lack of resources/lack of access to services
Adjustment disorder
Recent stressors in life
Mood lability and preoccupation on stressor
Typically resolves after 6 months
Psychotic symptoms not seen
Psychotic depression
Recent psychosocial stressors
Older age and chronic medical conditions are risk factors
Core features of depression reported
Paranoid psychosis rare
Visual hallucinations uncommon
Behavioral and psychological symptoms of dementia
Known history of vascular insult to brain
Delusions and hallucinations seen
Age is a risk factor
