Psychiatric Illness of Medical Conditions

Question 1

Systemic Illness and Psychiatric Symptoms

Answer 1

Often exist as comorbidities.

25-30% of primary care patients and 40-50% of hospitalized patients have psychiatric comorbidities.

Substance abuse in young patients, and cognitive impairment of older patients.

Question 2

Delirium

Answer 2

“Brain failure”

Very very high number of causes.

Up to 20% of patients with untreated delirium die and if you have had delirium within the last year, the odds of dying in the next year is 50%.

Question 3

Causes of Delerium

Answer 3

D - drugs

E - electrolyte imbalance

L - lack of drugs

I - infection

R - reduced sensory input

I - intracranial

U - urinary/fecal retention

M - myocardial

Question 4

Neurotransmitters and Delerium

Answer 4

Overstimulation or understimulation of any neurotransmitter group can lead to a delerium.

Serotonin syndrome, neuroleptic malignant syndrome, delirium tremens, and anticholinergic delerium all look very similar. All have flunctuating LOC, inattention, autonomic instability, hallucinations.

Question 5

Specific Features of Delirium Tremens

Answer 5

(GABA withdrawal)

Specific features: seizures

Question 6

Specific Features of Anticholinergic Delirium

Answer 6

Too much anti-cholinergic

Specific symptoms: flushed, dry, can’t see, can’t pee/shit

Question 7

Specific Features of Serotonin Delirium

Answer 7

Overstimulation of serotoninergic system

Specific symptoms: hypertonic reflexes, clonus, muscle fasciculations

Question 8

Specific Features of Neuromalignant Syndrome

Answer 8

Too much dopamine

Specific symptoms: Muscle rigidity —> elevated CK, myoglobinuria

Question 9

Haldol and Hallucinations

Answer 9

Delusions of delirium do NOT respond to haldol, the aim is to keep them sedated enough that they don’t hurt themselves.

Question 10

Flumazenil

Answer 10

The antidote to benzos.

The problem is that it will be competitively inhibit the benzos and if you give too much the person will seize and guess what the treatment for seizures are? Benzos…

Rarely gets used.

Question 11

When to Suspect Medical Etiology

Answer 11

Onset is acute

Visual, olfactory, and tactile hallucinations are present

Delusions are vague and patient is perplexed by them

Question 12

Medical Causes of Psychosis

Answer 12

Neuro - MS, seizure disorders, encephalitis, stroke, neoplasm, degenerative disorders

Metabolic disorders - B12 deficiency, hypoglycemia

Hepatic - failure leading to hyperammonemia, hyperbilirubinemia

Renal - hyper/hyponatremia, hyperuricemia, hyper/hypocalcemia

Endocrine - thyroid, adrenal, Cushing’s disease

Systemic infections

Question 13

Anxiety and CO2

Answer 13

Acidosis in the blood (increased CO2) can cause panic attacks.

Need to get air through the lungs and get rid of CO2.