Psychiatric Problems in the General Hospital Flashcards
Why are mental health problems not always recognised in the general hospital??
- May disguised themselves as physical disorder
- Focus on physical disorder, mental symptoms not inquired about
- Reaction considered to be normal
Why is there increasing prevalence of mental disorders in the general hospital?
- Challenges of physical illness (psychological, effect on brain, treatments of physical illness)
- Increased physical morbidity in patients with mental health problems
- Somatoform disorders
List some common mental health problems in the general hospital.
- Affective disorders (depression, anxiety)
- Self-harm
- Delirium (acute organic confusional state)
- Substance misuse disorders
- Medically unexplained symptoms (somatoform disorders)
- Personality disorders
- Dementia
- Eating disorders
What mental disorders are not commonly seen in the general hospital?
- Schizophrenia
- Bipolar affective disorder
- Severe depression
Why is depression twice as common in the general hospital than in the general population?
- More common in chronic illness, e.g. chronic renal failure, diabetes, rheumatoid arthritis
- Particularly common in certain neurological diseases, e.g. MS, Parkinson’s disease, stroke
- May be more difficult to detect due to overlap in symptomatology with physical disorder(s)
- More common in patients with previous history of depression
What is delirium characterised by?
- Global cognitive impairment
- Disorientation
- Fluctuating levels of arousal
- Impaired attention/concentration
- Disordered sleep wake cycle
- Increased/decreased motor activity -Disorganised thinking,
- Perceptual distortions
- Changes in mood,
What may delirium be mistaken for?
Schizophrenia
What can cause delirium?
- Infections
- Medications
- Alcohol/drug withdrawal
- Drug abuse
- Metabolic
- Vitamin deficiencies
- Endocrinopathies
- Neurological causes
- Toxins/industrial exposures
- SLE
- Cerebral vasculitis
- Paraneoplastic syndromes
What is the commonest reason for admission of females<65 years old?
Self harm
What do all patients admitted with self-harm routinely receive?
A psycho-social (psychiatric) assessment
What are the outcomes of self-harm?
- 15-20% of patients will repeat within one year
- ~ 1% of patients will go on to commit suicide within one year
- May be associated with a significant mental illness/ personality disorder
- Can indicate social problems
What is the commonest form of overdose?
Paracetamol overdose
How might someone with substance misuse/dependence present?
- Physical complications
- Intoxication
- Withdrawal (includes delirium, ARBD)
- Trauma/accident
- Drug-induced psychosis
- Feigned illness in order to obtain drugs
How do patients with medically unexplained physical symptoms present?
- Can present to any speciality but commonly neurology
- May undergo multiple investigations and treatment
- Often have significant disability
- May have an underlying psychiatric disorder
What is the principal cause of admission in those with dementia?
UTI or pneumonia
