Psychiatric Problems in General Hospital

Question 1

What can be the reasons why mental disorders are not always recognised in hospital?

Answer 1

1 - The psychiatric disorder may be disguised by the physical disorder

2 - The focus in hospitals is on physical symptoms and mental symptoms are not enquired about

3 - A psychological issue is thought to be a normal response to physical health problems

Question 2

What are the reasons for increased prevalence of psychiatric disorders in the hospital environement?

Answer 2

1) Challenges of physical illness:
- Psychological
- Effect of physical illness on brain functioning
- Treatment of physical illness
2) Increased physical morbidity in patients with mental health problems
3) Somatoform disorders

Question 3

What are the common mental health problems in the general hospital?

Answer 3

1 - Affective disorders (depression, anxiety)

2 - Self-harm

3 - Delirium (acute organic confusional state)

4 - Substance misuse disorders

5 - Dementia

6 - Personality disorders

Question 4

What are the less common psychiatric conditions encountered in the hospital?

Answer 4

1 - Schizophrenia

2 - Bipolar affective disorder

3 - Severe depression

Question 5

How much more common is depression in the hospital than in the general population?

Answer 5

2 times

Question 6

In what group of hospital patients is depression more common?

Answer 6

1 - Patients with chronic illness (renal failure, diabetes, RA)

2 - Neurological diseases (MS, Parkinsons, stroke)

Question 7

Why might depression be more difficult to detect in hospital patients?

Answer 7

The symptamology of depression may overlap with the physical disorder symptoms

Question 8

What type of assessment will all patients admitted with self-harm be given?

Answer 8

Psycho-social assessment

Question 9

How many self-harm patients will repeat within 1 year?

Answer 9

15-20%

Question 10

How many self-harm patients will go on to commit suicide within 1 year?

Answer 10

1%

Question 11

What is the most common drug taken in overdose?

Answer 11

Paracetamol

Question 12

What are commonly associated conditions/problems in patients performing self-harm?

Answer 12

1 - Substance misuse

2 - Social problems

3 - Personality disorder

Question 13

How many psychiatric hospital admissions are associated with ill effects of alcohol use?

Answer 13

20%

Question 14

How might patients suffering the ill effects of alcohol initially present?

Answer 14

• Physical complications
• Intoxication
• Withdrawal
• Trauma/accident
• Drug-induced psychosis

Question 15

What infections are the principle causes of admission in 40% of patients with dementia?

Answer 15

UTI’s

Pneumonia

Question 16

What are dementia patients at higher risk of suffering from?

Answer 16

Delirium

Question 17

What are the benefits of recognising psychatric disorders in general hospital patients?

Answer 17

1 - Shorten length of treatment in hospital

2 - Avoid unnecessary investigations and inappropriate treatment

3 - Enhance recovery process

Question 18

What are the mental health provisions within the general hospital?

Answer 18

1 - Liaison psychiatry services

2 - Psychologists

3 - Alcohol liaison nursing team