Phsycial / Metabolic & Endocrine / infectious

Question 1

What is somatisation disorder? Commonly seen in? Usual places? What do you need to do?

Answer 1

2 years of multiple physical sx with no physical explanation

Social + family functioning impairment

GI/skin

Rule out physical illness

Question 2

How does anxiety play a role in somatisation disorder

Answer 2

-> misinterpret bodily sensations -> increased anxiety -> worsens

Question 3

What is hypochondrial disorder? Management?

Answer 3

Fear of having serious illness

CBT

Question 4

What is dysmophobia ? Management?

Answer 4

Excessive preoccupation with imagined / barely noticeable physical defects
CBT
SSRIs

Question 5

What is dissociative disorder also called? What is it?

Answer 5

Conversion disorder
Physical / neuro sx occur in ABSENCE OF PATHOLOGY & have clear relationships with stressful events / disturbed relationships

Question 6

Egs of sx of conversion disorder

Answer 6

Motor / sensory - weakness, numbness, blindness
Convulsions (non epileptic) - up to 10% of people in epilepsy clinics
Dissociative fugue / amnesia - usually personal information forgotten (eg identity / memories and personality) -> upsetting

Question 7

Dissociative vs somatisation disorder ?

Answer 7

D - More signs

S - presents with Sx

Question 8

Who often has repeated requests for testing of HIV

Answer 8

Depression, anxiety, hypochondrial disorder, schitz

Question 9

What kind of psychological reactions do people tend to exhibit to a diagnosis /failing treatment for HIV

Answer 9

Acute stress reactions
Adjustment disorders
Anxiety / depression -> self harm / suicide

Question 10

How can mental illness increase risk of hiv

Answer 10

Impulsivity

Question 11

How does mental illness affect a diagnosis of HIV? What might you need to do?

Answer 11

Less likely to adhere to complicated antiretroviral treatment

May need to breach confidentiality

Question 12

Depression is common at all stages of HIV, what are the DDs of depression in HIV ? Risk with depression?

Answer 12

Decreased CD4 count + viral load -> fatigue / weight loss

Lack of adherence / self harm

Question 13

What is AIDS dementia complex also known as? What is it?

Answer 13

HAND - HIV Associated Neurocognitive Disorder

Due to direct HIV infection in brain
Opportunistic infections can also cause Eg syphilis, parvovirus, toxoplasmosis

Question 14

Usual cause of viral encephalitis ? Sx?

Answer 14

Herpes simplex

Severe headache, vomiting, reduced consciousness

Question 15

What is general paralysis of the insane? Which disease does it occur in? What are the features? How do you test for it? What’s the treatment?

Answer 15

Tertiary syphilis - occurs many years after initial infection

Cognitive - poor concentration
Dementia 30%
Depression 25%
Grandiosity - can rarely occur with mania / other psychoses

Test - VDRL (venereal disease research laboratory test)

Treat - IM penicillin

Question 16

What transmission is acute intermittent porphyria? what does it affect? Sx?

Answer 16

AD - affects heme production
ABDO PAIN, constipation, vomiting, peripheral neuropathy, epilepsy
Psych - Delirium (50%), depression, emotional liability and schitz like psychoses

Question 17

Hypothyroidism
Depression/Anxiety?
Behavioural disturbance?
Psychosis?

Answer 17

Both
Irritability, occasional apathy and poor appetite
Psychotic depression

Question 18

Hypothyroidism / hyperparathyroidism
Depression/Anxiety?
Behavioural disturbance?
Psychosis? 
Cognitive change?

Answer 18

Both
Acute agitation, apathy and emotional liability
Some hallucinations post parathyroidectomy
DELIRIUM, dementia, poor concentration, cognitive impairment

Question 19

Usual cause of hypercorticoidaemia ? Psych sx?

Answer 19

Iatrogenic

Mania

Question 20

What is hypocorticoidaemia ? Behavioural change?

Answer 20

Addison’s

Apathy

Question 21

Usual cause of Addison’s? Common Sx? What is an adrenal crisis and sx?

Answer 21

Primary adrenal insufficiency - Autoimmune usually (often TB in developing world)
Abdo pain, weakness, weight loss, darkening of areas of skin

Low BP, lower back pain, vomiting, loss of consciousness

Question 22

Management of Addison’s

Answer 22

Corticosteroids

Eg hydrocortisone

Question 23

Hypopituitarism
Depression/Anxiety?
Behavioural disturbance?
Cognitive change?

Answer 23

Depression
Irritability
Impaired memory

Question 24

How does vitamin b12 deficiency lead to psych symptoms? What are they?

Answer 24

-> pernicious anaemia + subacute degeneration of the spinal cord
-> neuropathy and spinal cord signs
Psych - mental slowing, confusion, memory problems, intellectual impairment