Psychiatric disorders and physical health Flashcards
1
Q
What is an adjustment reaction?
A
- states of subjective distress and emotional disturbance, usually interfering with social functioning
- arises in the period of adaptation to a significant life change or stressful life event
- manifestations vary: depressed mood, anxiety or worry, feeling unable to cope, plan ahead, or continue in the present situation, as well as some degree of disability in the performance of daily routine
2
Q
What is an organic delusional disorder?
A
- persistent or recurrent delusions
- may be hallucinations also
- may be some features suggestive of schizophrenia, such as bizarre hallucinations or thought disorder
- organic means physical cause (e.g. linked to stroke)
3
Q
What is the prevalence of psychosis after stroke?
A
- delusions 4.67%
- hallucinations 5.05%
- more common in right hemisphere strokes
4
Q
What are common delusional themes in post-stroke psychosis?
A
- persecutory
- jealousy
- environment
5
Q
What are some long term medical conditions that are associated with increased risk of mental illness?
A
- cardiovascular diseases 3x risk of depression and anxiety
- diabetes 2x risk of depression
- COPD 10x risk of panic disorder
- musculoskeletal disorders 2x risk of depression
6
Q
What are some examples of physical illnesses that cause discrete mental illness?
A
- thyrotoxicosis–> anxiety, mania
- thyroid deficiency–> depression, dementia
- Cushing’s disease–> depression, mania
- infections (syphilis, HIV)–> psychosis
- cancer–> depression
- Parkinson’s disease–> depression, anxiety, dementia
7
Q
How does chronic mental illness affect physical health?
A
- people with chronic mental illness die 20 years younger than general population
- diet, exercise, smoking, alcohol, drugs, medication side effects, poverty
8
Q
What factors may affect timely diagnosis of physical disorders in people with mental illness?
A
- illness behaviour (more tolerant to symptoms, so don’t seek help)
- diagnostic overshadowing (signed off as part of mental health condition e.g. aching joints)
- stigma (barrier to care)
- lack of resources (not enough funding)
9
Q
What is the Montreal cognitive assessment?
A
- 30 points
- visual
- words
- numbers
- abstract tests
- memory
10
Q
What is delirium/acute confusional state?
A
- essentially physical illness with psychiatric manifestation
- 50% undetected bc hypoactive
- untreated delirium raises mortality to about 40%
- organic cerebral syndrome characterised by concurrent disturbances of consciousness and attention, perception, thinking, memory, psychomotor behaviour, emotion and sleep-wake schedule
- ranges from mild to very severe
- variable duration
11
Q
What causes delirium?
A
- infection
- change in environment/ward
- medication (esp. opiates, anticholinergics, steroids)
- alcohol withdrawal
- surgery
- pain
- liver/renal impairment
- hypoxia
- hyponatraemia
- stroke
- encephalitis
- constipation
- urine retention
- dehydration
12
Q
What are predisposing factors for delirium?
A
- advanced age
- dementia (often undetected)
- impaired activities of daily living
- immobility
- sensory impairment (may lose hearing aid, glasses, teeth)
- urinary catheterisation
- malnutrition
- alcohol
- depression
13
Q
How do you manage delirium?
A
- anticipate!
- modify risk factors if possible
- early diagnosis
- treat the cause
- good nursing: single room, well lit, familiar staff in ideal world
- medication (eh)
- wait!
14
Q
What is stigma?
A
- challenges faced by people with mental/physical illness
- knowledge, attitudes, and behaviour of people they meet
- due to poor understanding of mental health, negative’s attitude, social exclusion
- leads to discrimination–> education, work, relationships
- pervasive and widespread (75% of people with mental illness experience stigma)
15
Q
What are the 3 different types of stigma?
A
- intrapersonal stigma: internalised discrimination, compounded by direct effects of illness
- interpersonal stigma: family, friends, colleagues
- structural stigma: poor resources and funding, and poor access to physical healthcare
