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
How does acute medical admissions of those with dementia vary with age and sex??
- Females higher prevalence
- Prevalence increases with age
What effect does dementia have on a general hospital stay?
-It is often not recognised
-Cognitive impairment can be exacerbated by physical problems
-Increases risk of delirium
-Often affects patients management
Increases length of hospital stay
What is the importance of recognising psychiatric disorders in general hospital patients?
- Provide appropriate mental health treatment
- Shorten length of treatment in hospital
- Avoidance of unnecessary investigations and inappropriate treatment
- Enhance recovery and rehabilitation process
- Improve quality of life
What mental health provisions are currently in the general hospital?
- Liaison psychiatry services for adults
- Psychology (some departments)
- Alcohol liaison nursing team
- Ward teams
- Pastoral care
- There is no specific counselling service
How do those with eating disorders present in the general hospital?
- 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
