Psychiatric Problems in the General Hospital

Question 1

Reasons for the increased prevalence of mental illness in general hospital patients

Answer 1

Challenges of physical illness

Increased physical morbidity in patients with mental health problems

Question 2

Common mental health problems that occur in the general hospital

Answer 2

Affective disorders (depression, anxiety)
Self-harm
Delirium (acute organic confusional state)
Substance misuse disorders
Medically unexplained symptoms (somatoform disorders)
Personality disorders
Dementia
Eating disorders

Question 3

Depression in the general hospital.

Answer 3

It is hugely common (twice as common as the general public), perhaps due to chronic illness and neurological disorders. More common in patients with previous history of depression.

Question 4

Characteristic of Delirium

Answer 4

Disorientation in time and place
Fluctuating levels of arousal
Impaired attention/concentration
Disordered sleep wake cycle
Increased/decreased motor activity (hyperactive/hypoactive delirium)
Disorganised thinking, as indicated by rambling, irrelevant or incoherent speech
Perceptual distortions leading to misidentification, illusions or hallucinations
Changes in mood, such as anxiety, depression and lability of mood

Question 5

Causes of Delirium

Answer 5

Infections 
Medications
Alcohol/drug withdrawal
Drug abuse
Metabolic
Vitamin deficiencies
Endocrinopathies 
Neurological causes
Toxins/industrial exposures
SLE 
Cerebral vasculitis
Paraneoplastic syndromes

Question 6

Commonest reason for admission in females <65

Answer 6

Self-harm

Question 7

Commonest drug taken in overdose

Answer 7

Paracetamol

Question 8

Percentage of repeated self harm

Answer 8

15-20%

Question 9

Percentage of self harm patients that will go on to attempt suicide

Answer 9

1%

Question 10

Percentage of hospital admissions directly related to the ill effects of alcohol use

Answer 10

20%

Question 11

Substance misuse/dependence can present as

Answer 11

physical complications
intoxication
withdrawal (includes delirium, Alcohol Related Brain Damage )
trauma/accident
drug-induced psychosis (e.g. legal highs)
feigned illness in order to obtain drugs

Question 12

Dementia in the general hospital

Answer 12

Often not be recognised
Cognitive impairment can be exacerbated by physical problems
Increases risk of delirium
Often affects patients management
Increases length of hospital stay

Question 13

Eating Disorders

Answer 13

Primary physical disorder may initially be suspected
More common in younger females but can present at any age, males also affected
May initially require physical stabilisation and appropriate diagnosis